An adult client with extreme fatigue, weight gain, cold intolerance, and bradycardia is diagnosed with hypothyroidism. Which laboratory findings is this client likely to exhibit?

Tumor lysis syndrome (TLS) is a potentially life-threatening oncologic emergency characterized by the rapid release of intracellular contents into the bloodstream following the destruction of cancer cells. This release can lead to metabolic disturbances, including hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Here's how the child's laboratory results are indicative of tumor lysis syndrome:

A) Wilm's tumor:

Wilms tumor is a type of kidney cancer that primarily affects children. However, it typically does not cause the metabolic disturbances seen in tumor lysis syndrome. Laboratory abnormalities in Wilms tumor are generally related to renal dysfunction and may include hematuria and proteinuria.

B) Tumor lysis syndrome:

Correct. Tumor lysis syndrome occurs when chemotherapy or radiation therapy causes a rapid breakdown of cancer cells, leading to the release of intracellular contents such as potassium, phosphorus, and uric acid into the bloodstream. The elevated potassium and phosphorus levels seen in the child's laboratory results are consistent with tumor lysis syndrome. Hyperkalemia (elevated potassium) and hyperphosphatemia (elevated phosphorus) are common metabolic disturbances in tumor lysis syndrome.

C) Superior vena cava syndrome:

Superior vena cava syndrome occurs when the superior vena cava, a major vein that carries blood from the upper body to the heart, becomes partially or completely obstructed. This obstruction can lead to symptoms such as facial swelling, dyspnea, and dilated neck veins. While superior vena cava syndrome may occur in cancer patients, it does not typically cause the metabolic disturbances seen in the child's laboratory results.

D) Hyperleukocytosis:

Hyperleukocytosis refers to an extremely high white blood cell count, which can occur in leukemia. While leukemia can lead to metabolic abnormalities, the child's laboratory results, particularly the elevated potassium and phosphorus levels, are more indicative of tumor lysis syndrome than hyperleukocytosis.

A) The usual types of reactions are mediated by antibodies:

Correct. Types I, II, and III hypersensitivity reactions are mediated by antibodies (IgE, IgG, or IgM) that bind to antigens and trigger immune responses. In contrast, Type IV hypersensitivity reactions are T-cell mediated and do not involve antibodies.

B) B-lymphocytes produce the offending substances:

This statement is incorrect. B-lymphocytes are involved in antibody-mediated immune responses (types I, II, and III hypersensitivity reactions), not Type IV hypersensitivity reactions, which are primarily mediated by T-lymphocytes.

C) They typically occur with the first exposure to an antigen:

This statement is incorrect. Type IV hypersensitivity reactions usually require sensitization upon initial exposure to an antigen, and subsequent exposures elicit the delayed hypersensitivity response. This is similar to types I, II, and III hypersensitivity reactions, which also involve sensitization upon initial exposure.

D) Delayed reactions are characterized by cytokine release:

This statement is partially correct. Type IV hypersensitivity reactions are characterized by a delayed onset (typically 24 to 72 hours after exposure) and involve the release of cytokines from activated T-lymphocytes, leading to inflammation and tissue damage. However, other types of hypersensitivity reactions may also involve cytokine release, so this feature alone does not differentiate Type IV from other types of reactions.