A client with tumor lysis syndrome is being managed in the emergency department. Which nursing intervention should the nurse implement to prevent acute kidney injury?

Choice A rationale Tumor lysis syndrome is an oncologic emergency characterized by the rapid release of intracellular contents, including potassium, phosphate, and nucleic acids, into the bloodstream. These nucleic acids are metabolized into uric acid, which can precipitate in the renal tubules, leading to obstructive uropathy and acute kidney injury. Aggressive hydration, typically 3 liters or more daily, is the primary intervention to increase urine flow, dilute the concentration of these substances, and promote their renal excretion. Choice B rationale The semi-Fowler's position is primarily utilized to improve lung expansion and decrease the work of breathing in patients with respiratory distress or to prevent aspiration. While comfortable, it does not directly address the underlying pathophysiology of tumor lysis syndrome or the prevention of acute kidney injury. The priority in this metabolic emergency is maintaining high intravascular volume and renal perfusion to clear the excessive load of electrolytes and uric acid produced by the rapidly lysing malignant cells. Choice C rationale Obtaining blood cultures is a standard intervention for suspected sepsis or systemic infection but is not a primary treatment for tumor lysis syndrome. While oncology patients are often immunocompromised and at risk for infection, the immediate threat in tumor lysis syndrome is metabolic derangement and renal failure. Nurses should focus on monitoring electrolyte levels, such as potassium (normal 3.5 to 5.0 mEq/L) and phosphorus (normal 2.5 to 4.5 mg/dL), and ensuring aggressive fluid resuscitation rather than diagnostic tests for infection. Choice D rationale High-dose intravenous corticosteroids are not the standard treatment for preventing acute kidney injury in the context of tumor lysis syndrome. While steroids may be part of the chemotherapy regimen that initially triggered the cell lysis, the management of the resulting syndrome involves hydration, allopurinol or rasburicase to lower uric acid levels, and the management of electrolyte imbalances. Corticosteroids do not assist in the clearance of uric acid or the protection of renal tubules from metabolic crystalline deposits. .