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WorksheetsAnatomical Structures of the Immune System
Total questions: 70
Worksheet time: 35mins
Which site is a primary location for hematopoiesis in adults?
Thymus gland in mediastinum
Spleen in left upper quadrant
Bone marrow in vertebrae and ribs
Liver sinusoids filtering blood
Which cell type differentiates into various blood lineages within bone marrow?
Activated mast cells
Mature neutrophils
Circulating eosinophils
Stem cells
Which pairing correctly matches lymphocyte subtype with its principal product or marker?
B cells produce cytokines only
B cells present CD4 and CD8 markers
T cells secrete immunoglobulins primarily
T cells express CD4 and CD8 markers
Which structure primarily supports T-cell maturation before peripheral circulation?
Spleen in reticuloendothelial system
Peyer’s patches in ileum
Thymus in anterior mediastinum
Lymph nodes along vessels
Which function is most characteristic of lymph nodes within the lymphatic system?
Storage of immunoglobulin G
Detoxification of eicosanoids
Filtration of lymph fluids
Production of red blood cells
What role best distinguishes the spleen from the liver in immune surveillance?
T-cell maturation pathway
Filtration of blood-borne pathogens
Return of tissue fluid to blood
Cytokine synthesis by leukocytes
Which feature best distinguishes innate immunity from acquired immunity as shown in the diagrams?
Present at birth, no memory, broad response
Antibody production through plasma cell differentiation
Activated by exposure, highly specific, long memory
Tolerance failure leading to autoimmune disease
In the first line of defense, which example represents a mechanical barrier?
Complement protein cascade
Coughing and sneezing reflexes
Skin with keratinized epithelium
Enzymes in secretions like lysozyme
Which component belongs to the second line of defense within innate immunity?
B cell antibody secretion
Inflammation and fever
Vaccination-derived antibodies
Self–non-self tolerance
Which cell type primarily targets virus-infected cells in cell-mediated immunity?
B lymphocytes producing antibodies
T lymphocytes cytotoxic subsets
Neutrophils performing phagocytosis
Natural killer cells in innate responses
A newborn gains antibodies through breast milk. Which immunity category applies?
Passive artificial immunity
Passive natural immunity
Active artificial immunity
Active natural immunity
Vaccination leads to which immunity pathway illustrated?
Passive natural immunity from maternal transfer
Passive artificial immunity via gamma globulin
Active artificial immunity with antibody development
Innate immunity via mechanical barriers
Which scenario best exemplifies tolerance failure as depicted?
Recognition of self antigens prevents attack
Memory B cells produce neutralizing antibodies
Complement activation enhances opsonization
Loss of self-recognition causing autoimmune disease
Which option correctly orders the immune system’s lines of defense from nonspecific to specific in the classification figure?
Chemical barriers, phagocytes, T and B cells
Antibodies, NK cells, mechanical barriers
Phagocytes, mechanical barriers, protective proteins
Reflexes, antibodies, inflammation and fever
Which is most characteristic of antibody-mediated immunity (AMI) as shown?
Targets viruses and cancer through cytotoxic cells
Relies on antibodies with active or passive acquisition
Initiates inflammation during early innate responses
Depends entirely on mechanical removal processes
Receiving gamma globulin injection provides which type of immunity?
Passive artificial immunity from medicine
Active natural immunity after infection
Innate immunity through protective proteins
Cell-mediated immunity via T cell activation
Which total WBC range is considered normal in adults?
3,000–7,000/mm³
5,000–10,000/mm³
8,000–14,000/mm³
10,000–18,000/mm³
Which leukocyte typically comprises the highest proportion in a normal differential?
Lymphocytes 20–40%
Eosinophils 1–4%
Neutrophils 55–70%
Monocytes 2–8%
Leukopenia is best defined as which finding?
WBC less than 4,000/mm³
ANC greater than 1,000/mm³
WBC greater than 10,000/mm³
Bands greater than 20% of WBC
Which condition commonly causes leukocytosis?
Older age without fever
Acute infection or inflammation
Bone marrow failure syndromes
Autoimmune disease activity
Which formula correctly calculates Absolute Neutrophil Count (ANC)?
ANC = WBC − (% basophils + % eosinophils)
ANC = WBC × (% neutrophils + % bands)
ANC = WBC ÷ (% monocytes + % eosinophils)
ANC = WBC × % lymphocytes
At what ANC threshold are neutropenic precautions required?
ANC less than 1,500/mm³
ANC less than 2,000/mm³
ANC less than 1,000/mm³
ANC less than 500/mm³
A patient’s WBC is 9,000/mm³ with 60% neutrophils and 10% bands. What is the ANC?
7,200/mm³
4,500/mm³
5,400/mm³
6,300/mm³
Which nursing action is appropriate for a patient on neutropenic precautions?
Encourage thorough washing of produce
Allow live potted plants at bedside
Use rectal temperature monitoring
Schedule frequent IM injections
Which lymphocyte subset primarily mediates cell‑mediated immunity (CMI)?
Plasma cells antibody secretion
T cells in cellular immunity
B cells in humoral immunity
Natural killer cells cytotoxicity
An adult’s lymphocyte percentage rises to 35%. Which scenario most plausibly explains this increase?
Acute bacterial pneumonia case
Acute allergic urticaria
Iron deficiency anemia
Viral mononucleosis infection
Which finding is most consistent with decreased lymphocytes?
Sepsis with lymphopenia
Chronic viral hepatitis
Mumps infection exposure
Lymphocytic leukemia
Which leukocyte is best matched to its primary function?
Monocytes—phagocytosis in chronic inflammation
Monocytes—release histamine during allergy
Basophils—mediate parasites and eczema
Eosinophils—phagocytose chronic inflammation
A patient with wheezing and pruritic rash has elevated eosinophils. Which additional condition commonly increases eosinophils?
Acute stress response
Parasitic helminth infection
Aplastic bone marrow failure
Bacterial sepsis syndrome
Which laboratory pattern most strongly suggests basophil involvement in symptoms?
Low eosinophils causing leukemia
High basophils releasing histamine
Low basophils causing protozoal infection
High monocytes driving allergies
Which statement best describes the pathophysiology of leukemia?
Viral infection creating hyperfunctional neutrophils
Cancer causing overproduction of immature white cells
Autoimmune destruction of mature lymphocytes only
Bone loss leading to pancytopenia without malignancy
Leukemic cells crowd normal marrow. Which consequence primarily explains bleeding risk?
Enhanced clot breakdown by leukocyte enzymes
Elevated fibrinogen from hepatic overactivity
Autoantibodies against endothelial receptors
Suppressed platelet production in the marrow
Which site is a common metastasis location for leukemia?
Metastasis limited to pulmonary alveoli
Exclusive spread to skeletal muscle
Only peripheral nerves are affected
Liver and spleen involvement is typical
Infections are a leading cause of death in leukemia primarily because of:
Immunosuppression from reduced mature white cells
Excessive red cell turnover causing hypoxia
Hypercoagulability leading to microthrombi
Malabsorption of essential micronutrients
Differentiate acute from chronic leukemia by disease course.
Chronic always remits spontaneously
Chronic presents only in pediatric patients
Acute is rapid onset and aggressive
Acute has slow progression over years
By cell lineage, leukemia is classified as:
Epithelial or mesenchymal types
Endocrine or exocrine types
Neuronal or glial types
Lymphoid or myeloid types
A patient with fatigue, frequent infections, and bruising most likely has which marrow changes?
Enhanced platelet production preventing hemorrhage
Crowding by leukemic blasts suppressing normal cells
Hyperplasia of mature neutrophils increasing immunity
Selective red cell expansion improving oxygen delivery
Which leukemia is most common in children and has the highest reported 5-year survival among the listed types?
ALL with ~91% child survival
CML with blast crisis risk
AML with ~26% adult survival
CLL in adults over 50 years
A 58-year-old patient presents with fatigue and lymphocytosis. Which leukemia is most commonly diagnosed in this age group?
ALL in pediatric populations
AML common in younger adults
CML exclusively in teenagers
CLL most common adult leukemia
Which phase of CML is characterized by aggressive behavior and metastatic potential?
Accelerated phase with gradual change
Remission phase post induction
Blast phase with aggressive spread
Chronic phase with stable counts
Which diagnostic test confirms leukemia and distinguishes myeloid from lymphoid lineage?
Chest radiograph imaging
Serum chemistry panel
Bone marrow biopsy procedure
Peripheral smear alone
During initial workup, which CBC finding commonly supports leukemia?
Elevated blast cell percentage
High HDL cholesterol level
Low creatinine concentration
Normal electrolytes throughout
Which treatment is foundational and typically delivered in three phases for leukemia care?
Antibiotics for definitive cure
Radiation as primary modality
Analgesics for disease control
Chemotherapy with phased protocols
A patient with recurrent infections, poor wound healing, and pallor most likely exhibits which complication of leukemia?
Anemia causing fatigue and dyspnea
Migraine disorder causing aura
Hyperlipidemia causing xanthomas
Hypothyroidism causing bradycardia
Which statement best defines lymphoma in terms of pathophysiology?
Congenital absence of lymph vessels
Autoimmune attack on bone marrow
Bacterial infection of lymph nodes
Malignancy of lymphocyte cells
What is the typical site of initial tumor formation in lymphoma?
Lymph nodes
Bone marrow
Hepatic sinusoids
Pulmonary alveoli
Which feature distinguishes Hodgkin’s lymphoma from Non-Hodgkin’s lymphoma regarding spread?
Predictable spread pattern
Primarily central nervous system spread
Rapid hematogenous spread
Always confined to one organ
Which age distribution is characteristic of Hodgkin’s lymphoma?
Bimodal peaks: teens and 50s–60s
Uniform across all ages
Predominantly infants under two
Only adults over seventy
Which microscopic finding is diagnostic for Hodgkin’s lymphoma, as labeled in the image?
Granulomas with caseating necrosis
Sheets of plasma cells
Clusters of neutrophil microabscesses
Presence of Reed–Sternberg cells
Which statement about Non-Hodgkin’s lymphoma is accurate?
Spread is consistently predictable
Begins in a single node chain
Always curable with high survival
More common in older adults and males
Bone marrow involvement in lymphoma typically occurs when compared with leukemia?
Later than leukemia
Earlier than leukemia
Only in pediatric leukemia
At the same time as leukemia
Which clinical finding most strongly suggests Hodgkin lymphoma involvement of cervical lymph nodes?
Painful tender neck nodes with erythema
Painless enlarged neck lymph nodes noted on exam
Generalized pruritus without lymph node changes
Firm movable axillary nodes with mild soreness
Which set best represents classic B-symptoms seen in lymphoma?
Fever, night sweats, weight loss
Edema, dyspnea, orthopnea
Headache, nausea, photophobia
Fever, chills, productive cough
A patient with lymphoma reports abdominal fullness. What pathophysiology most likely explains this symptom?
Ascites from hepatic failure
Ileus from chemotherapy toxicity
Organ enlargement causing mass effect
Peritonitis due to bacterial translocation
Which diagnostic finding confirms Hodgkin lymphoma on lymph node biopsy?
Reed–Sternberg cells in lymph tissue
Auer rods within myeloblasts
Smudge cells on peripheral smear
Philadelphia chromosome in leukocytes
A patient undergoing chemotherapy for lymphoma becomes neutropenic. Which nursing action is most appropriate to prevent infection?
Permit fresh flowers to improve mood
Place in a private room and enforce hand hygiene
Encourage raw salads for nutrition
Avoid mouth care to limit mucosal trauma
Which intervention best addresses bleeding risk in leukemia with thrombocytopenia?
Encourage high-impact exercise for fitness
Schedule frequent intramuscular injections
Start aspirin daily for cardioprotection
Monitor platelet counts and avoid trauma
A patient post–stem cell transplantation asks about warning signs to report. Which instruction is most critical?
Report any weight gain over two pounds
Report thirst that improves after fluids
Report mild fatigue after activities only
Report fever at or above 100°F promptly
Which immune cells are the primary targets of HIV during infection?
B lymphocytes
NK lymphocytes
CD8+ T lymphocytes
CD4+ T lymphocytes
HIV is best classified as which type of virus?
Positive-sense RNA virus
Double-stranded DNA virus
Nonenveloped adenovirus
Enveloped retrovirus
Which enzyme allows HIV to convert its RNA into DNA within host cells?
DNA ligase
RNA polymerase II
Reverse transcriptase
Integrase kinase
Which body fluids are primary sources of HIV transmission?
Sputum, gastric juice, pancreatic juice
Cerebrospinal fluid, synovial fluid, bile
Saliva, sweat, tears, urine
Blood, semen, vaginal secretions, breast milk
A public health nurse designs a screening protocol. Who should be universally screened for HIV according to best practice?
Only symptomatic adults
Only hospitalized patients
All pregnant clients
Only high-risk adolescents
A patient develops flu-like symptoms 3 weeks after a known exposure and has high viral load with decreased CD4+ and increased CD8. Which stage best fits this presentation?
Stage 3 AIDS diagnosis
Stage 2 chronic HIV infection
Stage 1 acute HIV infection
Latent HIV carrier state
Which finding most characterizes chronic HIV infection in stage 2?
Marked lymphadenopathy persists
Very high CD4+ cell counts
Often asymptomatic HIV positive
Immediate opportunistic infections
Which combination indicates an AIDS diagnosis when present together?
HIV positive and asymptomatic for many years
CD4+ 200–499 and gradual immune decline
High viral load and persistent lymphadenopathy
CD4+ <200 or <14% and AIDS-defining condition
Which is a common AIDS-defining condition listed for stage 3?
Pneumocystis jirovecii pneumonia
Seasonal allergic rhinitis
Acute bacterial sinusitis
Primary hypertension
Without treatment at stage 3 AIDS, the typical prognosis is best described as:
Rapid cure after antibiotics
Full recovery within one year
Death within approximately five years
Stable health for decades
A client’s CD4+ count is 350 cells/mm³ with CD4% of 20%. Which stage classification aligns with these values?
Stage 3 AIDS diagnosis
Stage 2 chronic HIV infection
Indeterminate non-HIV status
Stage 1 acute HIV infection
Which CD4+ threshold most directly signals progression to AIDS in staging?
Count between 200 and 499 cells/mm³
Count greater than 500 cells/mm³
Count less than 200 cells/mm³
Count exactly 250 cells/mm³
