A nurse is teaching a client with lung cancer about smoking cessation.
Which statement by the client indicates understanding?

Choice A rationale

Hypophosphatemia, a low level of phosphate, is not typically expected in tumor lysis syndrome (TLS). Instead, the rapid breakdown of tumor cells releases intracellular components, including large amounts of phosphate, leading to hyperphosphatemia, not hypophosphatemia.

Choice B rationale

Hypokalemia, a low level of potassium, is not expected in tumor lysis syndrome. The lysis of tumor cells releases significant quantities of intracellular potassium into the bloodstream, leading to hyperkalemia, which is a life-threatening electrolyte imbalance due to its impact on cardiac function.

Choice C rationale

Hypouricemia, a low level of uric acid, is not expected in tumor lysis syndrome. The rapid catabolism of purines from lysed tumor cells leads to a massive production of uric acid, resulting in hyperuricemia. This can precipitate in the renal tubules, causing acute kidney injury.

Choice D rationale

Hyperkalemia is a hallmark laboratory finding in tumor lysis syndrome. The rapid destruction of large numbers of cancer cells releases their intracellular contents into the bloodstream. Since potassium is abundant within cells, its release leads to a significant elevation in serum potassium levels. Normal potassium levels are 3.5 to 5.0 mEq/L.

Choice A rationale

Referring the patient to psychiatry immediately, while potentially necessary later, may not be the most appropriate initial nursing intervention. The patient's feelings of overwhelm and hopelessness are a normal emotional response to a new, chronic diagnosis like multiple sclerosis. A direct and immediate psychiatric referral might feel dismissive of their current emotional state without first addressing their immediate need for information and support, which is within the nurse's scope.

Choice B rationale

Providing information about treatment options and support resources is the most appropriate initial nursing intervention. This empowers the patient by reducing uncertainty and fostering a sense of control. Education on disease progression, symptom management, and available therapies (e.g., immunomodulators) addresses their immediate anxiety about the future. Connecting them with support groups (e.g., National Multiple Sclerosis Society) provides emotional validation and coping strategies from peers.

Choice C rationale

Telling the patient that everything will be fine is an example of false reassurance, which is an ineffective therapeutic communication technique. While well-intentioned, it minimizes the patient's valid feelings of fear and hopelessness associated with a chronic, progressive neurological condition like multiple sclerosis. This approach can lead to a loss of trust between the patient and nurse, making the patient feel misunderstood and isolated.

Choice D rationale

Encouraging the patient to accept the diagnosis, while a long-term goal, is not the most appropriate initial intervention. Acceptance is a process that unfolds over time and often follows stages of grief. Directly telling someone to accept a new, life-altering diagnosis can be perceived as demanding and insensitive. The immediate focus should be on providing support, information, and resources to help them begin this complex emotional journey at their own pace.