# The nurse reviews findings after chemotherapy for a fast-growing lymphoma. Which findings require immediate follow-up? Highlight the findings that indicate possible tumor lysis syndrome and organ risk. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=497304&lang=en > language: en > subject: Complications of Procedures > category: ROR ## Question The nurse reviews findings after chemotherapy for a fast-growing lymphoma. Which findings require immediate follow-up? Highlight the findings that indicate possible tumor lysis syndrome and organ risk. Nurses' Notes 2200: The client is 18 hours after the first chemotherapy dose for bulky Burkitt lymphoma. At 2210, the chemistry panel shows that serum potassium increased to 6.1 mEq/L from 4.2 mEq/L. The handoff notes that nausea improved and no vomiting recurred after the prescribed antiemetic was given. The pretreatment report confirms that uric acid was 5.8 mg/dL on the completed panel before chemotherapy began. The current panel shows that serum phosphorus increased to 6.8 mg/dL from 3.7 mg/dL. The nurse verifies that serum calcium was 9.1 mg/dL on the completed pretreatment panel. At 2215, the flow sheet shows that urine output falls to 12 mL/hr while creatinine rises to 2.1 mg/dL. The intravenous assessment confirms that prescribed hydration is infusing through a patent line without alarms or leakage and the programmed hourly volume is displayed correctly. Telemetry currently shows that sinus rhythm continues without premature complexes on the bedside monitor. The client also reports that fatigue is unchanged from handoff and has continued since the chemotherapy session ended. At 2220, the client reports that new perioral tingling occurs with visible carpal spasm. The nurse places the client on continuous monitoring and immediately reports suspected tumor lysis syndrome. Repeat electrolyte testing and emergency treatment are prepared as prescribed. ## Explanation Hyperkalemia, hyperphosphatemia, acute oliguria with rising creatinine, and hypocalcemic neuromuscular irritability require immediate follow-up. Rapid tumor breakdown can cause lethal dysrhythmias, seizures, and acute kidney injury. ## In-depth explanation Quick answer Highlight potassium 6.1 mEq/L, phosphorus 6.8 mg/dL, urine output 12 mL/hr with rising creatinine, and perioral tingling with carpal spasm. This cluster after chemotherapy strongly suggests tumor lysis with immediate renal, cardiac, and neurologic risk. Why this is correct Rapidly destroyed tumor cells release potassium, phosphate, and nucleic-acid products into blood. Uric acid and calcium-phosphate precipitation can injure the kidneys, while hyperkalemia and secondary hypocalcemia can trigger dysrhythmias, tetany, seizures, or sudden deterioration.[2] Easy analogy or mental picture Imagine many overfilled cells breaking open into one small drainage system. Minerals and waste flood the bloodstream and clog the kidney filter; the picture explains the direction of change but not laboratory thresholds or treatment selection. Memory hook Cells burst: potassium, phosphate, uric acid rise; calcium and urine fall. NCLEX decision rule After therapy for a high-burden, fast-growing cancer, prioritize new electrolyte shifts, declining urine output, creatinine rise, dysrhythmia, or neuromuscular irritability and escalate before organ injury progresses. Why the other choices are wrong A controlled nausea episode, normal pretreatment uric acid, normal calcium before chemotherapy, patent hydration infusion, sinus rhythm, and expected fatigue provide context. They do not cancel the new post-treatment abnormalities or carry the same urgency.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]NCI: Tumor Lysis SyndromeNational Cancer Institute ## Related questions - [A nurse cares for a client 12 hours after thoracotomy with a chest tube connected to a wet…](https://mymerci.kr/pages/nclex_q.php?qn_id=366310&lang=en) - [A nurse is caring for a 64-year-old client 2 hours after a diagnostic cardiac catheterizat…](https://mymerci.kr/pages/nclex_q.php?qn_id=368186&lang=en) - [A patient on mechanical ventilation has bilateral infiltrates on chest x-ray, no signs of …](https://mymerci.kr/pages/nclex_q.php?qn_id=372717&lang=en) - [A 38-week newborn is delivered limp, apneic, and cyanotic. 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