A nurse is caring for a patient undergoing intensive combination chemotherapy after being diagnosed with leukemia. Which order would the nurse anticipate for tumor lysis syndrome?

Choice A reason: Oral polystyrene sulfonate (Kayexalate) is used to treat hyperkalemia, a key electrolyte abnormality in tumor lysis syndrome (TLS). TLS results from rapid cell lysis releasing potassium, phosphate, and uric acid into the bloodstream. Kayexalate helps remove excess potassium via the gastrointestinal tract. Choice B reason: Beta-1 antagonists are not standard treatment for TLS. They may be used for cardiac conditions but do not address the metabolic derangements of TLS such as hyperkalemia, hyperphosphatemia, or hyperuricemia. Choice C reason: Fluid restriction is contraindicated in TLS. Aggressive IV hydration is essential to prevent acute kidney injury by promoting renal clearance of solutes. Intake and output monitoring is important, but fluid restriction would worsen the condition. Choice D reason: Blood glucose monitoring is not a primary intervention for TLS. While glucose levels may be monitored in chemotherapy patients, TLS management focuses on electrolyte balance, renal function, and uric acid control.