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Life-threatening hyperkalemia with ECG changes is an oncologic emergency that requires a stepwise but immediate approach. The first priority is membrane stabilization with IV calcium (gluconate preferred via peripheral line; chloride via central line) to reduce the risk of ventricular arrhythmias. Calcium does not lower serum potassium; it buys time for definitive measures. Next, drive potassium intracellularly with IV regular insulin (typically 10 units) plus dextrose to prevent hypoglycemia; nebulized albuterol can be added for additional intracellular shift. Begin potassium removal strategies as indicated—loop diuretics with adequate renal function, cation exchange resins in select cases, or dialysis when refractory or in renal failure. Because this scenario arises in tumor lysis syndrome, continue TLS management with aggressive IV hydration, rasburicase for hyperuricemia, avoidance of potassium/phosphate in fluids, and close telemetry with frequent labs. Relying on kayexalate alone (Option C) is too slow and carries GI risks. Observation (Option D) is unsafe in the presence of ECG changes. Insulin/dextrose without calcium first (Option A) leaves the patient vulnerable to malignant arrhythmias while interventions take effect. APRNs must act rapidly, coordinate ICU-level monitoring, and document response to each intervention.