A nurse is caring for a patient diagnosed with spinal cord compression due to a malignant tumor.
What is the most appropriate nursing intervention for this oncologic emergency?

Choice A rationale

This is accurate as it is an acute inflammatory demyelinating polyneuropathy. The immune system mistakenly attacks the myelin sheath of the peripheral nerves, which slows or blocks the conduction of nerve impulses. This autoimmune response is often triggered by a preceding infection. The destruction of myelin leads to varying degrees of muscle weakness and sensory loss. Early recognition is vital for initiating treatments like plasmapheresis or intravenous immunoglobulin therapy to limit nerve damage.

Choice B rationale

This is accurate because many cases are preceded by a gastrointestinal infection, most notably by the bacterium Campylobacter jejuni. Respiratory infections are also common triggers. The theory of molecular mimicry suggests that the immune system produces antibodies against the infecting pathogen that cross-react with similar antigens on the peripheral nerve myelin. This link between a recent illness and the onset of neurological symptoms is a key diagnostic feature used during the patient's history taking.

Choice C rationale

This is inaccurate because Reye's syndrome is a completely different condition characterized by acute encephalopathy and fatty infiltration of the liver, typically following a viral illness in children who took aspirin. Miller Fisher syndrome, not Reye's syndrome, is the well-known variant of this condition, characterized by the triad of ataxia, areflexia, and ophthalmoplegia. Confusing these two syndromes could lead to incorrect diagnostic paths and inappropriate management strategies for the affected patient.

Choice D rationale

This is accurate and represents the most serious complication of the syndrome. As the ascending paralysis progresses, it can reach the intercostal muscles and the diaphragm. This leads to acute respiratory failure, necessitating frequent monitoring of forced vital capacity and negative inspiratory force. Up to thirty percent of patients may require mechanical ventilation during the peak of the illness. Prompt transfer to an intensive care unit is required if respiratory involvement is suspected.

Choice E rationale

This is inaccurate as the condition slightly favors males more than females, and it can affect individuals of any age. Unlike many other autoimmune diseases that have a strong female predominance, this syndrome does not show that pattern. Epidemiological studies consistently show a slightly higher incidence in men. Understanding the demographic distribution helps clinicians maintain a high index of suspicion in any patient presenting with rapid, symmetrical, ascending motor weakness regardless of their gender.

Choice F rationale

This is accurate as the classic presentation involves symmetrical weakness and paresthesia that begins in the feet and legs and moves toward the trunk and upper body. This is often referred to as ascending paralysis. The loss of deep tendon reflexes, such as the Achilles and patellar reflexes, usually accompanies the muscle weakness. This characteristic pattern of progression is a hallmark of the disease and helps distinguish it from other neurological disorders that might present more randomly. .

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. .