A nurse is caring for a client newly diagnosed with multiple myeloma. Which finding should the nurse identify as the priority?

A. A serum calcium level of 12.5 mg/dL indicates significant hypercalcemia, which is a common and life-threatening complication of multiple myeloma due to excessive bone resorption. High calcium levels can lead to cardiac dysrhythmias, renal failure, and altered mental status, necessitating immediate clinical intervention. This finding represents an acute physiological instability that takes priority over chronic symptoms like fatigue or pain. B. Extreme fatigue is a common symptom in multiple myeloma, often resulting from the underlying malignancy, anemia, or the metabolic demands of the disease. While distressing to the client, it does not pose an immediate threat to life when compared to severe electrolyte imbalances. The nurse should address fatigue through energy conservation techniques after ensuring that more critical metabolic parameters are stabilized. C. A hemoglobin level of 10 g/dL reflects mild anemia, which frequently occurs in multiple myeloma as malignant plasma cells crowd out normal erythropoietic tissue in the bone marrow. Although this requires monitoring and potential future treatment, it is not an emergency situation for most stable adult clients. The nurse must prioritize the hypercalcemia, which has a higher potential for causing rapid systemic collapse and organ damage. D. Lower back pain is a hallmark manifestation of multiple myeloma caused by lytic bone lesions and pathological fractures within the spinal column. While pain management is a central component of nursing care, it is considered a secondary priority to the management of severe hypercalcemia. Correcting the calcium levels is essential to prevent further physiological deterioration, whereas pain is a subjective symptom that does not immediately jeopardize systemic homeostasis.