Nokea
The nurse is explaining the role of red blood cells with oxygen transport in the body with a nursing student. Which term should the nurse use to describe hemoglobin that has given up its oxygen to the body's cells?
- A. Reduced
- B. Detached
- C. Oxyhemoglobin
- D. Hypoxyhemoglobin
Correct Answer: A
Rationale: The correct term to describe hemoglobin that has given up its oxygen to the body's cells is "Reduced." When hemoglobin releases oxygen to the body's cells, it becomes deoxygenated or reduced hemoglobin. This term accurately reflects the chemical state of the hemoglobin molecule after oxygen release.
Summary of other choices:
- B: "Detached" does not accurately describe the process of oxygen release by hemoglobin.
- C: "Oxyhemoglobin" refers to hemoglobin bound to oxygen, not after it has given up oxygen.
- D: "Hypoxyhemoglobin" refers to hemoglobin with low oxygen levels, not after it has given up oxygen.
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Blinatumomab, a bispecific T-cell engaging molecule, is active against which CD antigen that is expressed on B-lymphoblasts?
- A. CD10
- B. CD15
- C. CD19
- D. CD20
Correct Answer: C
Rationale: Rationale:
1. Blinatumomab is designed to engage T cells to target CD19 antigen on B-lymphoblasts.
2. CD19 is a specific marker expressed on B cells, making it a target for Blinatumomab.
3. CD10 is not targeted by Blinatumomab and is commonly found on early B-cell precursors.
4. CD15 and CD20 are not targeted by Blinatumomab and have different functions unrelated to B-lymphoblasts.
Summary:
- CD19 is the correct answer as it is the specific target for Blinatumomab on B-lymphoblasts.
- CD10, CD15, and CD20 are incorrect as they are not the targeted antigens for Blinatumomab and have different roles in immune function.
A nursing student wants to know why clients with chronic obstructive pulmonary disease tend to be polycythemic. What response by the nurse instructor is best?
- A. It is due to side effects of medications for bronchodilation.
- B. It is from overactive bone marrow in response to chronic disease.
- C. It combats the anemia caused by an increased metabolic rate.
- D. It compensates for tissue hypoxia caused by lung disease.
Correct Answer: D
Rationale: The correct answer is D. In chronic obstructive pulmonary disease (COPD), the lungs are unable to efficiently exchange oxygen and carbon dioxide, leading to tissue hypoxia. The body compensates for this by producing more red blood cells (polycythemia) to increase oxygen-carrying capacity. This helps deliver more oxygen to tissues.
Choice A is incorrect because medications for bronchodilation do not directly cause polycythemia. Choice B is incorrect because overactive bone marrow is not the primary reason for polycythemia in COPD. Choice C is incorrect because polycythemia in COPD is not a response to combat anemia but rather to address tissue hypoxia.
A 14-year-old Syrian male with beta thalassemia major has relocated to your community as a refugee. He has been receiving chronic transfusion therapy in Turkey for the past 3 years. On his first visit, you notice that his height is below the fifth percentile. He has skin discoloration and hepatosplenomegaly. His mother reports they have not had regular access to chelation therapy. Laboratory testing shows a serum ferritin of 6,200 ng/mL. A cardiac MRI shows grossly normal cardiac function but a T2* value of 9 ms. What is the most likely cause of his short stature?
- A. Lack of regular blood transfusion causing growth failure
- B. Cirrhosis and liver failure
- C. Ineffective erythropoiesis and chronic anemia
- D. Growth hormone deficiency due to iron deposition in the pituitary
Correct Answer: D
Rationale: The correct answer is D: Growth hormone deficiency due to iron deposition in the pituitary. Iron deposition in the pituitary gland can lead to impaired production and secretion of growth hormone, resulting in short stature. This is a known complication of beta thalassemia major. The patient's elevated serum ferritin levels and T2* value of 9 ms indicate iron overload, which can cause damage to organs including the pituitary gland. Choices A, B, and C are incorrect because the patient's growth failure is primarily due to the impact of iron deposition on the pituitary gland rather than lack of transfusion, cirrhosis, or ineffective erythropoiesis. Regular chelation therapy is essential to prevent iron overload and its complications in patients with beta thalassemia major.
Which of the following statements about myeloablative, myeloablative but reduced toxicity, reduced intensity, and non-myeloablative approaches is not correct?
- A. Myeloablative approaches are needed for high-risk malignancies to maximize depth of remission and decrease the likelihood of relapse.
- B. Reduced intensity regimens can be successfully used for most nonmalignant disorders to minimize risk of late effects.
- C. Reduced intensity regimens can markedly decrease the risk of transplant-related mortality in patients who have underlying significant comorbidities but at the cost of more relapse and possibly more graft-versus-host disease.
- D. Non-myeloablative regimens are used for the very highest risk patients to minimize toxicity and for certain diseases such as aplastic anemia.
Correct Answer: B
Rationale: B is the correct answer because reduced intensity regimens are not suitable for most nonmalignant disorders. Myeloablative approaches are typically used for high-risk malignancies to maximize remission depth and reduce relapse likelihood. Reduced intensity regimens are used for patients with significant comorbidities to decrease transplant-related mortality, but may lead to more relapse and graft-versus-host disease. Non-myeloablative regimens are utilized for high-risk patients to minimize toxicity and for specific diseases like aplastic anemia.
A 4-year-old male child presents to the emergency department with his fourth invasive Staph infection. CBC consistently identifies moderate neutropenia. Sophisticated lab testing identifies lack of Toll-like receptor responses. The patient undergoes whole exome sequencing and is found to have pathogenic variants in IRAK4. What does 'IRAK4' stand for?
- A. Interferon gamma receptor-associated kinase 4
- B. Inducible RAS activating kinase 4
- C. Interleukin-1 receptor-associated kinase 4
- D. Immune response activating kinase 4
Correct Answer: C
Rationale: The correct answer is C: Interleukin-1 receptor-associated kinase 4 (IRAK4).
1. IRAK4 is involved in the immune response pathway triggered by interleukin-1 receptor signaling.
2. Lack of Toll-like receptor responses in the patient aligns with the role of IRAK4 in the interleukin-1 receptor pathway.
3. Pathogenic variants in IRAK4 can lead to immunodeficiency, explaining recurrent Staph infections.
4. Choices A, B, and D do not accurately reflect the known function of IRAK4 and its association with interleukin-1 receptor signaling.