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Severe hypercalcemia of malignancy (≥14 mg/dL) is a medical emergency. First-line therapy is vigorous isotonic IV fluids to restore intravascular volume and enhance calciuresis. Calcitonin provides rapid (but transient) reduction in calcium within hours—useful while definitive agents take effect. IV bisphosphonates (zoledronic acid or pamidronate) inhibit osteoclast-mediated bone resorption and produce sustained correction over 2–4 days. Denosumab is effective when bisphosphonates are contraindicated (renal failure) or ineffective. Loop diuretics (Option C) should only be considered after euvolemia is achieved to avoid worsening dehydration. Steroids (Option D) help in calcitriol-mediated hypercalcemia (e.g., certain lymphomas) but are not sufficient for common osteolytic mechanisms. The APRN should place the patient on cardiac monitoring, track urine output and electrolytes (beware hypophosphatemia/magnesemia), address underlying drivers (tumor control), and educate on hydration and medication effects. Early palliative interventions for symptoms (nausea, constipation, confusion) improve comfort while definitive therapy works.