2.1.3: Heat and its measurements
-
- Last updated
- Save as PDF
Heat
Heat is energy in transfer to and from a thermodynamic system by a mechanism other than the work or the transfer of matter.
Energy exists in different forms, but energy transforms from one form to another through work or heat. In chemical reactions, a significant portion of energy transfer happens through heat. Green leaves in plants trap the energy from light and store it as chemical energy in the form of glucose synthesized from water and carbon dioxide, as illustrated in Fig. 1.8.1.
A reverse process happens when we eat food, i.e., the food substances are converted to carbon dioxide, water, and energy, as illustrated in Fig. 1.8.2. Some energy is used to maintain our body temperature at an average level. Another portion is used to drive chemical reactions that consume energy and synthesize substances we need.
Body Temperature
The human body continually loses energy as heat to the environment. The heat released by exothermic reactions in the food digestion process supplies the heat needed to maintain the body temperature at an average level. Human body temperature varies over a small range, as illustrated in Fig. 1.8.3. Hypothermia is <35.0 °C (95.0 °F), normal body temperate is 36.5–37.5 °C (97.7–99.5 °F), fever and hyperthermia is >37.5 or 38.3 °C (99.5 or 100.9 °F), Hyperpyrexia is >40.0 or 41.0 °C (104.0 or 105.8 °F).
Measurement of heat
Temperature is a manifestation of the thermal energy of an object, but the temperature and the energy are not the same. Temperature is a measure of hotness or coldness, and it is intensive, and energy is an extensive physical property of matter. For example, 1 g of water has some energy, but 2 g of water at the same temperature has twice the energy.
Specific heat
The calory (c or cal) is a non-SI unit of heat, work, and energy.
The calory (c or cal)
The energy needed to raise the temperature of 1 g of water by 1 o C is 1 calory
The heat needed to raise the temperature of 2 g of water by 1 o C is 2 calory, and to raise the temperature of 2 g of water by 2 o C is 4 calory. That is, heat energy (q) is directly proportional to both the mass (m) and change in temperature (∆T) of an object:
\begin{equation}
q \propto m \Delta T\nonumber
\end{equation}
Introducing a constant of proportionality, i.e., specific heat (C s ) changes the proportionality to equality, that is known as the heat equation :
\begin{equation}
q=C_{s} m \Delta T\nonumber
\end{equation}
, where C s is Specific heat.
Specific heat of a substance
The heat energy needed to raise the temperature of 1g of a substance by 1 o C (or 1K) is specific heat if the substance.
The mathematical form of the definition of specific heat is:
\begin{equation}
C_{S}=\frac{q}{m \Delta T}\nonumber
\end{equation}
The units of specific heat are \(\frac{c a l}{g .^{\circ} \mathrm{C}}\), where cal is a non-SI unit of energy. The SI unit of energy is the joule (J). The following is an exact relationship between calory and joule:
\begin{equation}
1 \mathrm{~cal}=4.184 \mathrm{~J} \text { (exact) }\nonumber
\end{equation}
So, the specific heat (C s ) in SI units is: \(\frac{J}{g \cdot^{o} C}\)
The energy unit in nutrition and food is food calory or Calory (C) that is written with capital C, and it is equal to 1000 cal, i.e.,
\begin{equation}
\mathrm{C}=1000 \mathrm{~cal}=1 \mathrm{~kcal}=4184 \mathrm{~J}\nonumber
\end{equation}
, where the capital letter C is food calory.
The specific heat is a characteristic physical property of a material. It varies because the energies of vibrational motions of bonds and other motions that contribute to the thermal energy content differ from material to material. Table 1 lists specific heats of some familiar materials.
Water has higher specific heat than other materials, i.e., it absorbs or releases more heat for the same change in temperature. The environmental temperature variation remains moderate in coastal areas because the temperature change of water is less for the same amount of energy absorbed or released. Note that the specific heat of liquid water is different from solid water (ice) and gaseous water (steam).
| Substance | Specific heat ( \(\frac{J}{g \cdot^{o} C}\)) |
|---|---|
| Al | 0.902 |
| C (graphite) | 0.720 |
| Fe | 0.451 |
| Cu | 0.385 |
| Au | 0.128 |
| NH 3 (ammonia) | 4.70 |
| H 2 O (liquid) | 4.184 |
| H 2 O (ice) | 2.06 |
| H 2 O(steam) | 2.00 |
| C 2 H 5 OH (l) (ethanol) | 2.46 |
| (CH 2 OH) 2 (l) (ethylene glycol, antifreeze) | 2.42 |
| CCl 4 (carbon tetrachloride) | 0.861 |
| Wood | 1.76 |
| Concrete | 0.88 |
| Glass | 0.84 |
Calculations using specific heat
The specific heat values are used in the heat equation (\(q=C_{s} m \Delta T\)) to calculate the temperature change for a given amount of heat or the heat energy needed for a given temperature change of a material. A coffee cup calorimeter illustrated in Fig. 1.8.4 is commonly used. It consists of a coffee cup with a lid. It contains water in which the hot or cold object is immersed, or a chemical reaction is performed for heat exchange with the water. A wire loop is used to stir the water. A thermometer records the change in the temperature of the water. The heat absorbed or released by the water is calculated from the data of mass, specific heat, and temperature change of the water.
Example \(\PageIndex{1}\)
Immersing a hot object in 50.0 grams of water in a coffee cup calorimeter increased the water temperature from 22.0 o C to 28.8 o C. How much heat is gained or lost by water?
Solution
Given: m = 50.0 g water, C s = 4.184 (\frac{J}{g \cdot^{o} C}\), ∆T = T f – T i = 28.8 o C – 22.0 o C = 6.8 o C, Desired: heat gained or lost by water, i.e, q water = ?
Calculations:
\begin{equation}
\mathrm{q}_{\text {water }}=\mathrm{C}_{\mathrm{s}} \mathrm{m} \Delta \mathrm{T}=4.184 \frac{\mathrm{J}}{\mathrm{g}{ }^{\circ} \mathrm{C}} \times 50.0 \mathrm{~g} \times 6.8^{\circ} \mathrm{C}=+1400 \mathrm{~J}\nonumber
\end{equation}
The +ve sign tells water gained 1400 J heat.
Example \(\PageIndex{2}\)
Ammonium nitrate (NH 4 NO 3 ) is used as a cold pack in hospitals to decrease the temperature of a targeted skin area. When 3.21 g of NH 4 NO 3 is dissolved in 50.0 g of water in a coffee cup calorimeter at 25.0 o C, the temperature decreases to 20.4 o C. What is the amount of heat absorbed or released by water?
Solution
Given: m of solution = 50.0g H 2 O + 3.21 g NH 3 NO 3 = 53.2 g, C s = 4.184 (\frac{J}{g \cdot^{o} C}\), ∆T = T f – T i =20.4 o C - 25.0 o C = -4.6 o C, Desired: heat gained or lost by the solution, i.e, q solution = ?
Calculations:
\begin{equation}
\mathrm{q}_{\text {solution }}=\mathrm{C}_{\mathrm{s}} \mathrm{m} \Delta \mathrm{T}=4.184 \frac{\mathrm{J}}{g^{\circ} \mathrm{C}} \times 53.2 \mathrm{~g} \times\left(-4.6^{\circ} \mathrm{C}\right)=-1.0 \times 10^{3} \mathrm{~J}\nonumber
\end{equation}
The –ve sign tells water lost heat
Note
In the problems involving the heating of solution, the mass of solution includes the mass of water and the solute. It is assumed that the specific heat and density of the dilute solution are the same as that of pure water.
Example \(\PageIndex{3}\)
Calcium chloride (CaCl 2 ) is used as a hot pack, i.e., to raise the temperature of a targeted portion of the skin. When CaCl 2 dissolves in water, heat is released by the process and absorbed by the surrounding water, increasing the temperature of the water.
When 5.00 g of CaCl 2 is dissolved in 50.0 g of water at 23 o C in a coffee cup calorimeter, the temperature rises to 39.2 o C. What is the amount of heat absorbed or released by water?
Solution
Given: m of solution = 50.0g H 2 O + 5.00 g CaCl 2 = 55.0 g, C s = 4.184 (\frac{J}{g \cdot^{o} C}\), ∆T = T f – T i =39.2 o C - 23.0 o C = 16.2 o C, Desired: heat gained or lost by the solution, i.e, q solution = ?
Calculations:
\begin{equation}
\mathrm{q}_{\text {solution }}=\mathrm{C}_{\mathrm{s}} \mathrm{m} \Delta \mathrm{T}=4.184 \frac{\mathrm{J}}{g .^{\circ} \mathrm{C}} \times 55.0 \mathrm{~g} \times\left(16.2^{\circ} \mathrm{C}\right)=3.7 \times 10^{3} \mathrm{~J}\nonumber
\end{equation}
The +ve sign tells water gained heat.
The energy released from foods
Foods and fossil fuels are carbon and hydrogen compounds and may also contain some other elements like oxygen, nitrogen, phosphorous, and sulfur. Fuels are used in combustion reactions to release heat for different purposes. The same combustion reactions happen in living systems in several steps to get energy from the foods. For example, the chemical equation for the combustion of glucose is:
\[\ce{C6H12O6 (s) + 6O2 (g) -> 6CO2 (g) + 6H2O (l)}\quad\Delta \mathrm{H}^{\circ}=-2803 \mathrm{~kJ}\nonumber\]
, where ∆H o is the enthalpy of reaction, i.e., the heat evolved or absorbed at constant pressure conditions. This reaction releases 2803 kJ of energy as heat per mole of glucose. The –ve sign of ∆H o tells that the reaction releases the energy, i.e., the reaction is exothermic. The same amount of energy is released when glucose is digested and converted to the same products in the living system under the same conditions.
Measurement of energy released from food
The heat released from the combustion of a substance is measured using a bomb calorimeter illustrated in Fig. 1.8.5. The substance is placed in a particular cell surrounded by an excess of oxygen. An electric spark ignites the substance, and the heat released causes a temperature increase in the water and the other materials in the meter. The heat capacity (C cp ), i.e., the product of the meter's average specific heat and mass and the water components, is calibrated before the experiment. The heat released from the given amount of the substance is calculated from the heat capacity and the measured temperate increase.
Fuel value
The heat of combustion per g of a food is called the fuel value of the food
Glucose is one of the carbohydrates . Carbohydrates are food components that are compounds of carbon, hydrogen, and oxygen in which the ratio of hydrogen-to-oxygen is 2-to-1. The average fuel value of carbohydrates is 17 kJ/g.
The second major class of food is fat . For example, the chemical equation of tristearin C 57 H 110 O 6 , which is a fat, is:
\[\ce{2C57H110O6 (s) + 16O2 (g) -> 114CO2 (g) + 110H2O (l)}\quad\Delta \mathrm{H}^{\circ}=-71609 \mathrm{~kJ}\nonumber\]
The –ve sign with energy value tells the energy is released, or the reaction is exothermic. The average fuel value of fats is 38 kJ/g.
The third primary type of food is protein . Protein is mainly used as a building material in living systems, but it is also used as a source of energy. The average fuel value of protein is 17 kJ/g.
The average fuel values of the three major food components are listed in Table 2. These values are used to calculate the fule value of food servings, as explained in the following examples.
| Food | Fuel value kJ/g |
|---|---|
| Carbohydrates | 17 |
| Proteins | 17 |
| Fats | 38 |
Example \(\PageIndex{1}\)
Calculate the energy released from one cup of orange juice that contains 26 g of carbohydrates, no fat, and 2 g of protein.
Solution
Carbohydrate: \(26 \mathrm{~g} \times 17 \mathrm{~kJ} / \mathrm{g}=442 \mathrm{~kJ}\)
Protein: \(\quad\ 2 \mathrm{~g} \times 17 \mathrm{~kJ} / \mathrm{g}=34 \mathrm{~kJ}\)
Total energy released \(\quad\quad=476 \mathrm{~kJ}\)
The energy value in kJ can be converted to food calories (C) by using the conversion factor based on the following relations.
\begin{equation}
\text { Food calory C }=1000 \mathrm{~cal}=1 \mathrm{~kcal}=4184 \mathrm{~J}\nonumber
\end{equation}


4.6: Twitter
Twitter , founded in 2006, was initially designed as a “microblogging” platform for posting short public messages that would be aggregated in reverse chronological order. Now a publicly-traded company, it made its initial public offering (IPO) in 2013, making Jack Dorsey, one of its founders and its current CEO, an instant billionaire. At the time of the IPO, Twitter operated at a loss and did not post a profit until the first quarter of 2018 . Nearly all of its revenue is from advertising but some of it comes from licensing the use of the data it gathers from users to third parties. Its share of the digital advertising market falls well behind Google, Facebook, and Amazon and has a relatively small user base of 126 million daily active users. The tension between efforts to grow the user base and removing bots and abusive accounts that damage the brand has been a constant challenge for its business model.
How Twitter Influences the News
In spite of the fact it has far fewer users than Facebook or Snapchat, Twitter has a strong influence on news sharing because the platform design favors immediacy and provides a quick snapshot of trends. For example, the killing of Mike Brown in Ferguson, MO, and subsequent protests were barely visible on Facebook but dominated Twitter before journalists arrived to cover the story. Journalists rely on Twitter as a crowdsource platform – to get a sense of what is capturing public attention – as well as a place to promote and share new stories. An April 2019 survey from Pew Research suggests Twitter users in the United States are not demographically representative, but tend to skew left and young. Users of the platform in other countries may have a different profile.
Public figures have also found Twitter a platform for promoting ideas and getting reactions in real time. Unlike Facebook, Twitter does not rely on algorithms tied to your personal information to tailor what you see in your feed (though it uses algorithms to screen out some illegal or abusive material). What news you see primarily depends on who you follow and what they post or retweet in real time. Changes made in the platform have in subtle ways changed how people interact on Twitter. For example, one preliminary study showed allowing users to comment on a tweet by “tweet quoting” rather than simply replying appears to have somewhat improved the civility of political discourse and extended the conversation to a more politically diverse group of users. Further changes are in the works .
The use of Twitter by President Trump has bolstered the political influence of the platform far beyond its user base. It has also caused significant controversy. Users won a lawsuit against the president for blocking their accounts. (When public officials use social media, they are acting as agents of the government in a public forum. “The viewpoint-based exclusion of the individual plaintiffs from that designated public forum is proscribed by the First Amendment” according to the court’s decision, which is under appeal.) President Trump has, in other ways, benefitted by using Twitter as a public megaphone, frequently bypassing normal White House channels to announce policies or personnel decisions.
Twitter has also benefited from his frequent use. One analyst predicted the company would lose $2 billion if the president stopped using the platform, amounting to 20 percent of the company’s market capitalization. Though many users have reported tweets posted by the president for violating the platforms rules, his account has not been suspended or banned. In 2018 Twitter responded to complaints (without naming Trump) by announcing public figures have a special “newsworthy” status which exempts them from enforcement imposed on less prominent users, basically saying rules can be broken if you are important enough.
Twitter’s Culture(s)
The company’s current values statement is “We believe in free expression and think every voice has the power to impact the world.” Though Twitter’s policies ban threats of violence, doxxing, and “hateful conduct,” it has been markedly reluctant to enforce its policies . Amnesty International released a report in 2018 documenting how toxic the platform is for women, who are often threatened with violence for expressing themselves. Women of color in particular receive the worst abuse. Twitter CEO Jack Dorsey responded, saying “We love instant, public, global messaging and conversation. It’s what Twitter is and it’s why we’re here. But we didn’t fully predict or understand the real-world negative consequences.” In spite of multiple changes to its terms of use, abuse persists. In April, 2019 the company announced it was having some success removing abusive content using an algorithm rather than responding only to flagged content.
Twitter does not have a “real names” policy; users can create multiple accounts and do not have to disclose information about themselves beyond an email address. In its terms of service, Twitter forbids impersonating others, but allows parody and fan accounts. Users are able to choose whether to share location or other information and whether to have ads targeted to them or not. The data Twitter collects is used to build profiles for advertisers and is shared with some third parties; this appears to be a growing part of its business .
Twitter was the first social media company to introduce a verification process to enable some users to provide additional proof of identity and earn a “blue check” by their handle. Though some people mistake that as a marker of quality or authority, it simply means the company ascertained the person behind the account was real and had gained enough notoriety to be recognized with a check mark. Twitter was criticized for giving white supremacists who organized the Unite the Right rally verified accounts, removing them only as the rally approached. In 2018 the verification program was suspended so the company could redesign the program. The application process remains unavailable.
Automated accounts (bots) have presented a problem for the platform. The company acknowledged the wide use of bots and deleted tens of millions of suspect accounts in 2018, though recent research suggests real accounts supporting Trump in an organized mobilization may have been more influential than bots in the 2016 presidential election. That said, bots on Twitter continue to be a concern for 2019 elections in Sweden , Canada , Israel , India , and elsewhere.
Though Twitter is known for broadcasting opinions, it has also become a place where communities of interest gather and share information. Academics use it to share their research and keep in touch with others in their disciplines ( #Twitterstorians and #PhDchat are examples) or tweet during academic conferences. They also make use of Twitter’s application program interface (API) for analyzing public sentiment. “ Black Twitter ” became a phrase to describe the high percentage of African Americans (and black people elsewhere) using the platform for communication and activism . Twitter has also become a favored platform for white supremacists in part because it allows multiple account creation and anonymity, enforces its policies inconsistently, and is reluctant to take action against prominent extremists.
 Publicly-traded companies may be reluctant to take action that could depress earnings, but are also at risk if not taking action damages their brand or results in lawsuits or government sanction. In the public annual report to shareholders required by the Securities and Exchange Commission, Twitter identifies numerous risks faced by the company. Their 2018 transparency report report states the company over 200 million accounts were reported for “spam or abuse” in six months of 2018. Roughly a quarter million accounts were sanctioned for “abuse” and around 43,000 for making violent threats. The company also conducted a review of mistakes made during the 2016 election and outlined its efforts to combat malicious activity during the midterm election of 2018. Yet researchers have identified Twitter’s problematic delay in dealing with problems that can be identified quickly. Likewise, the findings of the Amnesty International report suggest the company does not take threats and abuse seriously enough.
The confluence of political influence and hate speech can be illustrated by President Trump’s endorsing a misleading video about Minnesota’s US Representative Ilhan Omar by retweeting it and adding a misleading comment, inflaming an already dangerous situation for the legislator who had been targeted with death threats on Twitter . A cybersecurity expert was able to find accounts aiming violence at the lawmaker within a couple of hours. He argues the platform could take greater responsibility by monitoring obvious threats and taking quick action. This will require a combination of algorithmic monitoring (which has shown some success) and human intervention, which should be made a priority. Hiring social scientists trained in anthropology, psychology, and communication studies could complement research and development efforts. There should also be some process for quarantining and saving records of account action that is under investigation by law enforcement, journalists, or researchers.
Additionally, like all advertising-funded platforms, laws must be passed and regulations enforced that make it possible to clearly label the source of funding for campaign advertisements and to ensure compliance with all campaign finance laws in countries where Twitter operates. Further, as licensing personal data becomes an increasingly important revenue stream, the company should prepare to comply with new privacy legislation such as the General Data Protection Regulation (GDPR) passed in the European Union and, as cyber risks proliferate, take measures to prevent breaches and hacks.
Finally, the company appears to have a dysfunctional management culture that makes it difficult to make hard decisions or implement improvements. Given the platform’s influence on the flow of information, particularly political news, it should make efforts to build a stronger, more stable and inclusive leadership structure.
Recommended Reading and Viewing
“ The Black Feminists Who Saw the Alt-Right Coming ” by Rachelle Hampton, Slate, April 2019.
How Twitter Needs to Change (Interview with Jack Dorsey) TED, April 2019.
Twitter and Teargas: The Power and Fragility of Networked Protest by Zeynep Tufekci (Yale, 2017).


15.10A: Ergot Poisoning
- List the causes and effects of ergot poisoning
Ergot poisoning is a type of illness associated with the ingestion of alkaloids produced by the fungi Claviceps purpurea (C. purpurea) . Claviceps purpurea is a fungus classified under the fungi genus Claviceps . This specific type of fungus is found on rye, and also on crops like wheat and barley. In addition, Claviceps purpurea can effect plants and crops that are typically considered forage plants. Thus, this type of fungus can also result in diseases within livestock.
The life cycle of C. purpurea begins when an ergot kernel, called a sclerotium, infects the host. The fungi continues to undergo proliferation and destroys the plant ovary. The first stage of ergot infection is a white soft tissue, called Sphacelia segetum, that drops out of the host. The white soft tissue contains asexual spores which infect additional host plants. This tissue, present within the host, is then converted into a hard Sclerotium clavus within the husk. At this specific stage, the alkaloids and lipids accumulate.
The alkaloids, responsible for the ergot poisoning, are naturally occurring compounds that are mainly comprised of basic nitrogen atoms. Alkaloids are produced within various organisms as a secondary metabolite. Secondary metabolites are most commonly produced in plants as a defense system. The alkaloids produced by fungi are often toxic. Specifically, the alkaloid produced by Claviceps purpurea is ergoline based.
In cases of ergot poisoning (also known as ergotoxicosis or traditionally, Saint Anthony’s Fire) alkaloids accumulate in the system due to the consumption of contaminated grain products. The symptoms which present in individuals with ergot poisoning can be classified as convulsive symptoms and gangrenous symptoms. The convulsive symptoms include seizures and effects on the central nervous system that range from hallucinations to psychotic episodes. The gangrenous symptoms are a result of vasoconstriction induced by the alkaloids. Peripheral systems, such as fingers and toes, are typically affected. More recently, ergot poisoning has been associated with an increased intake of ergot-based drugs. These drugs include those that promote vasoconstriction for treating migraines and Parkinson’s disease.
Key Points
- Ergot fungi typically infect rye, wheat and forage plants.
- Ingestion of the alkaloid toxins produced by the fungi can result in ergot poisoning in humans and foraging animals.
- Ergot poisoning can have either convulsive central nervous system effects or gangrenous symptoms caused by vasoconstriction effects.
Key Terms
- alkaloids : A class of organic heterocyclic bases.
- gangrenous : To be afflicted with gangrene.


6.14: Links to Primary Sources
Appian, Selections from Civil Wars on the Gracchi
legacy.fordham.edu/Halsall/an...n-civwars1.asp
Apuleius, Resources and Selections from Writings
http://faculty.georgetown.edu/jod/apuleius/
Augustus, Res Gestae Divi Augusti
http://classics.mit.edu/Augustus/deeds.html
Caesar, Gallic Wars and Civil War http://mcadams.posc.mu.edu/txt/ah/Caesar/index.html
Cicero, First Oration Against Catiline
http://www.bartleby.com/268/2/11.html
Etruscans (descriptions from Herodotus and Livy) legacy.fordham.edu/Halsall/an.../etrucans2.asp
Livy, The Rape of Lucretia and Roman way of declaring war legacy.fordham.edu/Halsall/an.../livy-rape.asp legacy.fordham.edu/Halsall/an...50livy1-34.asp
Passion of the Saints Perpetua and Felicity legacy.fordham.edu/halsall/source/perpetua.asp
Pliny, Correspondence with Trajan about Christians in Bithynia http://faculty.georgetown.edu/jod/texts/pliny.html
Pliny, Letters
legacy.fordham.edu/halsall/a...ny-letters.asp
Polybius, Histories , Books I and VI
http://penelope.uchicago.edu/Thayer/...lybius/1*.html legacy.fordham.edu/Halsall/an.../polybius6.asp
Polybius, Comparison of the Roman Maniple with Macedonian Phalanx legacy.fordham.edu/Halsall/an...us-maniple.asp
Sallust, The Conspiracy of Catiline http://www.forumromanum.org/literatu...catilinae.html
Slavery in the Roman Republic: collected documents legacy.fordham.edu/Halsall/an...ry-romrep1.asp
Suetonius, Lives
legacy.fordham.edu/Halsall/an...nius-index.asp
Tacitus, Annals and Histories
http://classics.mit.edu/Tacitus/annals.html http://classics.mit.edu/Tacitus/histories.html
The Twelve Tables


2.1: Prelude to Equations and Inequalities
selected template will load here
This action is not available.
For most people, the term territorial possession indicates restrictions, usually dealing with trespassing or rite of passage and takes place in some foreign location. What most Americans do not realize is that from September through December, territorial possession dominates our lifestyles while watching the NFL. In this area, territorial possession is governed by the referees who make their decisions based on what the chains reveal. If the ball is at point \(A (x_1,y_1)\), then it is up to the quarterback to decide which route to point \(B (x_2,y_2)\), the end zone, is most feasible.
Figure \(\PageIndex{1}\)


Skip to main content
5: Developmentally, Culturally, and Linguistically Appropriate Classroom Environments, Materials, and Approaches
-
-
Last updated
-
-
Save as PDF
-
Learning Objectives
-
Discuss developmentally appropriate practices.
-
Describe strategies to create culturally responsive early childhood education environments.
-
Evaluate the diversity of children’s books.
-
Identify how the importance of play relates to developmentally appropriate practices.
-
Compare and contrast different methods for teaching children about different cultures.
-
Outline practices for effectively working with culturally and linguistically diverse families.
-
Discuss perspectives on celebration of holidays in early childhood education programs.


<IP_ADDRESS>.2: Support Desk
Help-Desk/Support Analyst
Most mid-size to large organizations have their own information-technology help desk. The help desk is the first line of support for computer users in the company. Computer users who are having problems or need information can contact the help desk for assistance. Many times, a help-desk worker is a junior-level employee who does not necessarily know how to answer all of the questions that come his or her way. In these cases, help-desk analysts work with senior-level support analysts or have a computer knowledge base at their disposal to help them investigate the problem at hand. The help desk is a great place to break into working in IT because it exposes you to all of the different technologies within the company. A successful help-desk analyst should have good people and communications skills, as well as at least junior-level IT skills.
References
Help desk. (2021, August 12). Retrieved from https://en.Wikipedia.org/wiki/Help_desk


14.2: Nutrition Basic Concepts
Before discussing assessments and interventions related to promoting good nutrition, let’s review the structure and function of the digestive system, essential nutrients, and nutritional guidelines.
Digestive System
The digestive system breaks down food and then absorbs nutrients into the bloodstream via the small intestine and large intestine. Because good health depends on good nutrition, any disorder affecting the functioning of the digestive system can significantly impact overall health and well-being and increase the risk of chronic health conditions.
Structure and Function
The gastrointestinal system (also referred to as the digestive system) is responsible for several functions, including digestion, absorption, and immune response. Digestion begins in the upper gastrointestinal tract at the mouth, where chewing of food occurs, called mastication. Mastication results in mechanical digestion when food is broken down into small chunks and swallowed. Masticated food is formed into a bolus as it moves toward the pharynx in the back of the throat and then into the esophagus. Coordinated muscle movements in the esophagus called peristalsis move the food bolus into the stomach where it is mixed with acidic gastric juices and further broken down into chyme through a chemical digestion process. As chyme is moved out of the stomach and into the duodenum of the small intestine, it is mixed with bile from the gallbladder and pancreatic enzymes from the pancreas for further digestion. [1]
Absorption is a second gastrointestinal function. After chyme enters the small intestine, it comes into contact with tiny fingerlike projections along the inside of the intestine called villi. Villi increase the surface area of the small intestine and allow nutrients, such as protein, carbohydrates, fat, vitamins, and minerals, to absorb through the intestinal wall and into the bloodstream. Absorption of nutrients is essential for metabolism to occur because nutrients fuel bodily functions and create energy. Peristalsis moves leftover liquid from the small intestine into the large intestine, where additional water and minerals are absorbed. Waste products are condensed into feces and excreted from the body through the anus. [2] See Figure 14.1 [3] for labeled parts of the gastrointestinal system.
In addition to digestion and absorption, the gastrointestinal system is also involved in immune function. Good bacteria in the stomach create a person’s gut biome. Gut biome contributes to a person’s immune response through antibody production in response to foreign materials, chemicals, bacteria, and other substances. [4] For example, patients may develop Clostridium difficile (C-diff) after taking antibiotics that kill these beneficial bacteria in the gut. Read additional details about our microbiome and immune response in the “ Infection ” chapter of this book.
Essential Nutrients
Nutrients from food and fluids are used by the body for growth, energy, and bodily processes. Essential nutrients refer to nutrients that are necessary for bodily functions but must come from dietary intake because the body is unable to synthesize them. Essential nutrients include vitamins, minerals, some amino acids, and some fatty acids. [5] Essential nutrients can be further divided into macronutrients and micronutrients.
Macronutrients
Macronutrients make up most of a person’s diet and provide energy, as well as essential nutrient intake. Macronutrients include carbohydrates, proteins, and fats. However, too many macronutrients without associated physical activity cause excess nutrition that can lead to obesity, cardiovascular disease, diabetes mellitus, kidney disease, and other chronic diseases. Too few macronutrients result in undernutrition, which contributes to nutrient deficiencies and malnourishment. [6]
Carbohydrates
Carbohydrates are sugars and starches and are an important energy source that provides 4 kcal/g of energy. Simple carbohydrates are small molecules (called monosaccharides or disaccharides) and break down quickly. As a result, simple carbohydrates are easily digested and absorbed into the bloodstream, so they raise blood glucose levels quickly. Examples of simple carbohydrates include table sugar, syrup, soda, and fruit juice. Complex carbohydrates are larger molecules (called polysaccharides) that break down more slowly, which causes slower release into the bloodstream and a slower increase in blood sugar over a longer period of time. Examples of complex carbohydrates include whole grains, beans, and vegetables. [7]
Foods can also be categorized according to their glycemic index , a measure of how quickly glucose levels increase in the bloodstream after carbohydrates are consumed. The glycemic index was initially introduced as a way for people with diabetes mellitus to control their blood glucose levels. For example, processed foods, white bread, white rice, and white potatoes have a high glycemic index. They quickly raise blood glucose levels after being consumed and also cause the release of insulin, which can result in more hunger and overeating. However, foods such as fruit, green leafy vegetables, raw carrots, kidney beans, chickpeas, lentils, and bran breakfast cereals have a low glycemic index. These foods minimize blood sugar spikes and insulin release after eating, which leads to less hunger and overeating. Eating a diet of low glycemic foods has been linked to a decreased risk of obesity and diabetes mellitus. [8] See Figure 14.2 [9] for an image of the glycemic index of various foods.
Proteins
Proteins are peptides and amino acids that provide 4 kcal/g of energy. Proteins are necessary for tissue repair and function, growth, energy, fluid balance, clotting, and the production of white blood cells. Protein status is also referred to as nitrogen balance . Nitrogen is consumed in dietary intake and excreted in the urine and feces. If the body excretes more nitrogen than it takes in through the diet, this is referred to as a negative nitrogen balance. Negative nitrogen balance is seen in patients with starvation or severe infection. Conversely, if the body takes in more nitrogen through the diet than what is excreted, this is referred to as a positive nitrogen balance. [10] During positive nitrogen balance, excess protein is converted to fat tissue for storage.
Proteins are classified as complete, incomplete, or partially complete. Complete proteins must be ingested in the diet. They have enough amino acids to perform necessary bodily functions, such as growth and tissue maintenance. Examples of foods containing complete proteins are soy, quinoa, eggs, fish, meat, and dairy products. Incomplete proteins do not contain enough amino acids to sustain life. Examples of incomplete proteins include most plants, such as beans, peanut butter, seeds, grains, and grain products. Incomplete proteins must be combined with other types of proteins to add to amino acids and form complete protein combinations. [11] For example, vegetarians must be careful to eat complementary proteins, such as grains and legumes, or nuts and seeds and legumes, to create complete protein combinations during their daily food intake. Partially complete proteins have enough amino acids to sustain life, but not enough for tissue growth and maintenance. Because of the similarities, most sources consider partially complete proteins to be in the same category as incomplete proteins. See Figure 14.3 [12] for an image of protein-rich foods.
Fats
Fats consist of fatty acids and glycerol and are essential for tissue growth, insulation, energy, energy storage, and hormone production. Fats provide 9 kcal/g of energy. [13]  Due to its high-energy content, a little fat goes a long way.
Fats are classified as saturated, unsaturated, and trans fatty acids. Saturated fats come from animal products, such as butter and red meat (e.g., steak). Saturated fats are solid at room temperature. Recommended intake of saturated fats is less than 10% of daily calories because saturated fat raises cholesterol and contributes to heart disease. [14]
Unsaturated fats come from oils and plants, although chicken and fish also contain some unsaturated fats. Unsaturated fats are healthier than saturated fats. Examples of unsaturated fats include olive oil, canola oil, avocados, almonds, and pumpkin seeds. Fats containing omega-3 fatty acids are considered polyunsaturated fats and help lower LDL cholesterol levels. Fish and other seafood are excellent sources of omega-3 fatty acids.
Trans fats are fats that have been altered through a hydrogenation process, so they are not in their natural state.  Trans fats are found in processed foods, such as chips, crackers, and cookies, as well as in some margarines and salad dressings. Minimal trans fat intake is recommended because it increases cholesterol and contributes to heart disease. [15]
Micronutrients
Micronutrients include vitamins and minerals.
Vitamins
Vitamins are necessary for many bodily functions, including growth, development, healing, vision, and reproduction. Most vitamins are considered essential because they are not manufactured by the body and must be ingested in the diet. Vitamin D is also manufactured through exposure to sunlight. [16]
Vitamin toxicity can be caused by overconsumption of certain vitamins, such as vitamins A, D, C, B6, and niacin. Conversely, vitamin deficiencies can be caused by various factors including poor food intake due to poverty, malabsorption problems with the gastrointestinal tract, drug and alcohol abuse, proton pump inhibitors, and prolonged parenteral nutrition. Deficiencies can take years to develop, so it is usually a long-term problem for patients. [17]
Vitamins are classified as water soluble or fat soluble. Water-soluble vitamins are not stored in the body and include vitamin C and B-complex vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B12 (cyanocobalamin), and B9 (folic acid). Additional water-soluble vitamins include biotin and pantothenic acid. Excess amounts of these vitamins are excreted through the kidneys in urine, so toxicity is rarely an issue, though excess intake of vitamin B6, C, or niacin can result in toxicity. [18] See Table 14.2a for a list of selected water-soluble vitamins, their sources, and their function. [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27]
Table 14.2a Selected Water-Soluble Vitamins
| Water-Soluble Vitamin | Sources | Functions | Deficiency |
|---|---|---|---|
| C (Ascorbic Acid) | Citrus fruits, broccoli, greens, sweet peppers, tomatoes, lettuce, potatoes, tropical fruits, and strawberries | Infection prevention, wound healing, collagen formation, iron absorption, amino acid metabolism, antioxidant, and bone growth in children. | Early Signs: weakness, weight loss, myalgias, and irritability. Late Signs: scurvy; swollen, spongy gums; loose teeth; bleeding gums and skin; poor wound healing; edema; leg pain; anorexia; irritability; and poor growth in children. |
| B1 (Thiamine) | Nuts, liver, whole grains, pork, and legumes | Nerve function; metabolism of carbohydrates, fat, amino acids, glucose, and alcohol; appetite and digestion. | Fatigue, memory deficits, insomnia, chest pain, abdominal pain, anorexia, numbness of extremities, muscle wasting, heart failure, and shock in severe cases. |
| B2 (Riboflavin) | Eggs, liver, leafy greens, milk, and whole grains | Protein and carbohydrate metabolism, healthy skin, and normal vision. | Pallor, lip fissures, and seborrheic dermatitis. |
| B3 (Niacin) | Fish, chicken, eggs, dairy, mushrooms, peanut butter, whole grains, and red meat | Glycogen metabolism, cell metabolism, tissue regeneration, fat synthesis, nerve function, digestion, and skin health. | Pellagra characterized by skin lesions at pressure points/sun exposed skin, glossitis (swollen tongue), constipation progressing to bloody diarrhea, abdominal pain, abdominal distention, nausea, psychosis, and encephalopathy. |
| B6 (Pyridoxine) | Organ meats, fish, and various fruits and vegetables | Protein metabolism and red blood cell formation. | Rare due to presence in most foods. Peripheral neuropathy, seizures refractory to antiseizure medications, anemia, glossitis (swollen tongue), seborrheic dermatitis, depression, and confusion. |
| B9 (Folic Acid) | Liver, legumes, leafy greens, seeds, orange juice, and enriched refined grains | Coenzyme in protein metabolism and cell growth, red blood cell formation, and prevention of fetal neural tube defects in utero. | Glossitis (swollen tongue), confusion, depression, diarrhea, anemia, and fetal neural tube defects. |
| B12 (Cyanocobalamin) | Meat, organ meat, dairy, seafood, poultry, and eggs | Mature red blood cell formation, DNA/RNA synthesis, new cell formation, and nerve function. | Pernicious anemia from lack of intrinsic factor in intestines. Early Signs: weight loss, abdominal pain, peripheral neuropathy, weakness, hyporeflexia, and ataxia. Late Signs: irritability, depression, paranoia, and confusion. |
Fat-soluble vitamins are absorbed with fats in the diet and include vitamins A, D, E, and K. They are stored in fat tissue and can build up in the liver. They are not excreted easily by the kidneys due to storage in fatty tissue and the liver, so overconsumption can cause toxicity, especially with vitamins A and D. [28] See Table 14.2b for a list of selected fat-soluble vitamins, their sources, their function, and manifestations of deficiencies and toxicities. [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37]
Table 14.2b Selected Fat-Soluble Vitamins
| Fat-Soluble Vitamin | Source | Function | Deficiency | Toxicity |
|---|---|---|---|---|
| A (Retinol) |
Retinol: fortified milk and dairy, egg yolks, and fish liver oil
Beta carotene: green leafy vegetables, and dark orange fruits and vegetables |
Eyesight, epithelial, bone and tooth development, normal cellular proliferation, and immunity. | Night blindness, rough scaly skin, dry eyes, and poor tooth/ bone development. Causes poor growth and infections common with mortality >50%. | Dry, itchy skin; headache; nausea; blurred vision; and yellowing skin (carotenosis). |
| D | Milk, dairy, sun exposure, egg yolks, fatty fish, and liver | Changed to active form with sun exposure. Needed for calcium/ phosphorus absorption, immunity, and bone strength. | Rickets, poor dentition, tetany, osteomalacia, muscle aches and weakness, bone pain, poor calcium absorption leading to hypocalcemia and subsequent hyperparathyroidism and tetany. | Hypercalcemia resulting in nausea, vomiting, anorexia, renal failure, weakness, pruritus, and polyuria. |
| E | Green leafy vegetables, whole grains, liver, egg yolks, nuts, and plant oils | Anticoagulant, antioxidant, and cellular protection. | Red blood cell breakdown leading to anemia, neuron degeneration, neuropathy, and retinopathy. | Rare. Occasionally muscle weakness, fatigue, GI upset with diarrhea, and hemorrhagic stroke. |
| K |
Green leafy vegetables and green vegetables
*produced by bacteria in intestines |
Needed for producing clotting factors in the liver. | Rare in adults. Prolonged clotting times, hemorrhaging (especially in newborns causing morbidity & mortality), and jaundice. | Rare, but can interfere with effectiveness of certain anticoagulant medications (Warfarin). |
Minerals
Minerals are inorganic materials essential for hormone and enzyme production, as well as for bone, muscle, neurological, and cardiac function. Minerals are needed in varying amounts and are obtained from a well-rounded diet. In some cases of deficiencies, mineral supplements may be prescribed by a health care provider. Deficiencies can be caused by malnutrition, malabsorption, or certain medications, such as diuretics.
Minerals are classified as either macrominerals or trace minerals. Macrominerals are needed in larger amounts and are typically measured in milligrams, grams, or milliequivalents. Macrominerals include sodium, potassium, calcium, magnesium, chloride, and phosphorus. Macrominerals are discussed in further detail in the “Electrolytes” section of the “ Fluids and Electrolytes ” chapter of this book.
Trace minerals are needed in tiny amounts. Trace minerals include zinc, iron, chromium, copper, fluorine, iodine, manganese, molybdenum, and selenium. [38] See Table 14.2c for a list of selected macrominerals and Table 14.2d for a list of trace minerals. [39] , [40] , [41] , [42]
Table 14.2c Macrominerals
| Macromineral | Source | Function |
|---|---|---|
| Sodium | Table salt, spinach, and milk | Water balance |
| Potassium | Legumes, potatoes, bananas, and whole grains | Muscle contraction, cardiac muscle function, and nerve function |
| Calcium | Dairy, eggs, and green leafy vegetables | Bone and teeth development, nerve function, muscle contraction, immunity, and blood clotting |
| Magnesium | Raw nuts, spinach (cooked has higher magnesium content), tomatoes, and beans | Cell energy, muscle function, cardiac function, and glucose metabolism |
| Chloride | Table salt | Fluid and electrolyte balance and digestion |
| Phosphorus | Red meat, poultry, rice, oats, dairy, and fish | Bone strength and cellular function |
Table 14.2d Trace Minerals
| Trace Mineral | Source | Function |
|---|---|---|
| Zinc | Eggs, spinach, yogurt, whole grains, fish, and brewer’s yeast | Immune function, healing, and vision |
| Iron | Red meat, organ meats, spinach, shrimp, tuna, salmon, kidney beans, peas, and lentils (nonanimal forms are harder to absorb, so need more!) | Hemoglobin production and collagen production |
| Chromium | Whole grains, meat, and brewer’s yeast | Glucose metabolism |
| Copper | Shellfish, fruits, nuts, and organ meats | Hemoglobin production, collagen, elastin, neurotransmitter production, and melanin production |
| Flourine | Fluoridated water and toothpaste | Retention of calcium in bones and teeth |
| Iodine | Iodized salt and seafood | Energy production and thyroid function |
| Manganese | Whole grain and nuts | Not fully understood |
| Molybdenum | Organ meats, green leafy vegetables, legumes, whole grains, and dairy | Not fully understood; detoxification |
| Selenium | Broccoli, cabbage, garlic, whole grains, brewer’s yeast, celery, onions, and organ meats | Not fully understood |
Nutritional Guidelines
Nutritional guidelines are developed by governmental agencies to provide guidance to the population on how to best meet nutritional needs. These guidelines may vary by country. The National Academies of Sciences, Engineering, and Medicine set the Dietary Reference Intakes (DRIs) for the United States and Canada. Dietary Reference Intakes (DRIs) are a set of reference values used to plan and assess nutrient intakes of healthy people, including proteins, carbohydrates, fats, vitamins, minerals, and fiber. Nutrients included in the DRIs are obtained through a typical diet, although some foods may be fortified with certain nutrients that are commonly deficient in diets. [43]
Choose MyPlate Food Guide
The U.S. Department of Agriculture (USDA) issues dietary guidelines for appropriate serving sizes of each food group and number of servings recommended each day. The “Choose MyPlate” food guide is an easy-to-understand visual representation of how a healthy plate of food should be divided based on food groups. See Figure 14.4 [44] for a Choose MyPlate image. A little more than half of the plate should be grains and vegetables, with a focus on whole grains and a variety of vegetables. About one quarter of the plate should be fruits, with an emphasis on whole fruits. About one quarter of the plate should be protein, with an emphasis on consuming a variety of low-fat protein sources. All of these groups combined should make up no more than 85% of daily caloric intake based on a 2,000 calorie diet. Fats, oils, and added sugars are not included, but should make up no more than 15% of daily caloric intake. Foods should be selected that are as nutrient-dense as possible. Nutrient-dense means there is a high proportion of nutritional value relative to calories contained in the food, such as fruits and vegetables. Conversely, calorie-dense foods should be minimized because they have a large amount of calories with few nutrients. For example, candy and soda are calorie-dense with few nutrients and should be minimized. [45] , [46] See the following hyperlink to the MyPlate web site for further information on USDA dietary guidelines and patient educational materials.
MyPlate information and images are also available in several other languages so that education can be tailored to the patient’s preferred language. For example, Figure 14.5 [48] shows MyPlate in Vietnamese. This image would be accompanied with written information about food groups that include the patient’s typical dietary choices.
Vegetable Group
For a well-rounded diet, a variety of vegetables should be consumed, including vegetables from all five vegetable groups: dark green leafy vegetables; red and orange vegetables; beans, peas, and lentils (formerly called the legumes group); starchy vegetables; and other vegetables. Vegetables can be fresh, frozen, canned, or dried. Dark green leafy vegetables include kale, Swiss chard, spinach, broccoli, and salad greens. Red and orange vegetables include carrots, bell peppers, sweet potatoes, tomatoes, tomato juice, and squash. The beans, peas, and lentils group includes dried beans, black beans, chickpeas, kidney beans, split peas, and black-eyed peas. (Note that this group does not include green beans or green peas.) This vegetable group also supplies some protein and can be included in the protein group as well. Starchy vegetables include root vegetables, such as potatoes, as well as corn. The “other vegetables” category includes any vegetable that doesn’t fit in the other four categories, such as asparagus, avocados, brussels sprouts, cabbage, cucumbers, snow peas, and mushrooms, and a variety of others.
Daily serving suggestions of vegetables for individuals with a 2,000 calorie diet are 2 ½ cup equivalents of vegetables per day. For example, a “one cup equivalent” equals 1 cup raw or cooked vegetables, one cup 100% vegetable juice, ½ cup of dried vegetables, or 2 cups of leafy green vegetables. Approximately 90% of Americans do not meet the recommended daily intake of vegetables. [49] See Figure 14.6 [50] for an image of vegetables.
Grain Group
Grains are classified as whole grains or refined grains. Whole grains include the entire grain kernel and supply more fiber than refined grains. Examples of whole grains include amaranth, whole barley, popcorn, oats, whole grain cornmeal, brown or wild rice, and whole grain cereal or crackers. Refined grains have been processed to remove parts of the grain kernel and supply little fiber. As a result, they quickly increase blood glucose levels. Examples of refined grains include white bread, white rice, Cream of Wheat, pearled barley, white pasta, and refined-grain cereals or crackers. Some grains are fortified to ensure adequate intake of folic acid. See Figure 14.7 [51] for an image of whole grain whole wheat bread.
The daily serving suggestions of grains for an individual with a 2,000 calorie diet are six ounce equivalents per day, split equally between whole and refined grains. For example, a “one ounce equivalent” of grains equals ½ cup of cooked rice, pasta, or cereal or 1 cup of flaked cereal. Most Americans consume adequate amounts of total grains, although roughly 98% are deficient in recommended whole grain amounts, and 74% consume more than the recommended refined grain amounts. [52]
Fruit Group
Fruits can be frozen, canned, or dried, in addition to 100% fruit juice. A few examples of fruits include apples, oranges, bananas, melons, peaches, apricots, pineapples, and rhubarb. Daily serving suggestions of fruits for an individual with a 2,000 calorie diet are 2 cup equivalents per day. For example, “one cup equivalent” equals 1 cup of raw or cooked fruit, 8 ounces of 100% fruit juice, or ½ cup of dried fruit. Approximately 80% of Americans do not consume the recommended daily intake of fruits. [53] See Figure 14.8 [54] for an image of fruits.
Dairy Group
Dairy products can be liquid, dried, semi-solid, or solid depending on the type of product. Dairy products include milk, lactose-free milk, fortified soy milk, buttermilk, cheese, yogurt, and kefir. Sour cream and cream cheese are not considered dairy items in terms of nutritional benefits. Daily serving suggestions of dairy products for an individual with a 2,000 calorie diet are 3 cup equivalents per day. For example, “one cup equivalent” equals 1 cup of milk, soy milk, or yogurt; 1 ½ ounces of natural cheese, or 2 ounces of processed cheese. Approximately 90% of Americans consume less than the recommended daily intake of dairy products. [55] See Figure 14.9 [56] for an image of dairy products.
Protein Group
Proteins are categorized by the type of protein source. The meats, poultry, and eggs category consists of any type of animal or poultry meat, organ meat, or poultry egg. Lean meats should be selected to minimize fat and calorie intake from high-fat meats.
The seafood category includes any type of fish, clams, crab, lobster, oyster, and scallops. It is important to choose fish with low mercury levels to prevent negative effects of a buildup of mercury in the body. In general, large, fatty ocean fish, such as tuna, have higher levels of mercury due to their diet and storage of mercury in their fatty tissues.
The nuts, seeds, and soy products category includes tree nuts, peanuts, nut butters, seeds, or seed butters. Soy products include tofu and any other products made from soy. Unsalted nuts should be selected to avoid excess salt intake.
Protein is also contained in other food groups, such as dairy or the vegetable category of peas, beans, and lentils. Daily serving suggestions of proteins for individuals with a 2,000 calorie diet are 5 ½ ounce equivalents per day. Servings should total up to 26 ounce equivalents per week of meats, eggs, and poultry; 8 ounce equivalents per week of seafood; and 5 ounce equivalents per week of nuts, seeds, or soy products. A “one ounce equivalent” of protein equals 1 ounce of lean meat, one egg, ¼ cup cooked beans, or 1 tablespoon of peanut butter. Most Americans consume adequate amounts of protein, but many consume proteins high in saturated fat and sodium that contribute to diseases such as coronary artery disease. [57]
Oil/Fat Group
Examples of oils are vegetable oil, canola oil, olive oil, butter, lard, and coconut oil. Daily serving suggestions of fats or oils for individuals with a 2,000 calorie diet are 27 grams per day. While it is important to limit oils and fats due to their calorie-dense nature, some fat and oil intake is essential for nutrient absorption and overall health. It is best to select healthy unsaturated fats, such as avocados, nuts, or olive oil. [58]
Gender
A person’s gender affects their calorie and nutrient requirements. Males typically have higher calorie and protein needs related to increased muscle mass. Females typically require fewer calories to maintain their body weight due to a higher proportion of adipose (fat tissue) than muscle. Menstruating females also have higher iron requirements to offset losses that occur during menstruation.
Read Nutrition and Food Safety Information and Resources for Healthcare Professionals from the U.S. Food and Drug Administration.
View the infographic “ What’s MyPlate All About? ” from the USDA.
Factors Affecting Nutritional Status
Now that we have discussed basic nutritional concepts and dietary guidelines, let’s discuss factors that can affect a person’s nutritional status. Many things that can cause altered nutrition, such as physiological factors, cultural and religious beliefs, economic resources, drug and nutrient disorders, surgery, altered metabolic states, alcohol and drug abuse, and psychological states.
Physiological Factors
Nutritional intake is affected by several physiological factors. Appetite is controlled by the hypothalamus, a tiny gland deep within the brain that triggers feelings of hunger or fullness depending on hormone and neural signals being sent and received. See Figure 14.10 [59] for an image of the hypothalamus indicated by the red arrow. Hunger causes a feeling of emptiness in the abdomen and is often accompanied by audible noises coming from the abdomen as the stomach contracts due to emptiness. Hunger can cause feelings of discomfort, nausea, and tiredness. Satiety is a feeling of fullness that often comes after eating, although it can also be caused by impairments of the hypothalamus. Electrolyte imbalances and fluid volume imbalances can also trigger hunger and thirst by sending signals to the hypothalamus. [60]
The five senses play an important role in food intake. For example, food with a pleasing aroma may induce mouth watering and hunger, whereas food or environments with displeasing aromas often suppress the appetite. Texture and taste of foods also play a role in stimulation of appetite.
Poor dentition or poor oral care has a negative effect on appetite, so adequate oral care is crucial for patients prior to eating. [61] Additionally, the condition of a patient’s teeth and gums, the fit of dentures, and gastrointestinal function also play an important role in nutrition. Loose teeth, swollen gums, or poor-fitting dentures can make eating difficult.
Difficulty swallowing, called dysphagia , can make it dangerous for the patient to swallow food because it can result in pneumonia from aspiration of food into the lungs. Special soft diets or enteral or parenteral nutrition are typically prescribed for patients with dysphagia. Nurses collaborate with speech therapists when assessing and managing dysphagia.
A poorly functioning gastrointestinal tract makes nutrient absorption difficult and can result in malnourishment. Diseases that cause inflammation of the gastrointestinal tract impair absorption of nutrients. Examples of these conditions include esophagitis, gastritis, inflammatory bowel disease, and cholecystitis. Patients with these disorders should select nutrient-dense foods and may require prescribed supplements to increase nutrient intake.
Cultural and Religious Beliefs
Cultural and religious beliefs often influence food selection and food intake. It is important for nurses to conduct a thorough patient assessment, including food preferences, to ensure adequate nutritional intake during hospitalization. The nurse should not assume a particular diet based on a patient’s culture or religion, but instead should determine their individual preferences through the assessment interview.
Cultural beliefs affect types of food eaten and when they are eaten. Some foods may be restricted due to beliefs or religious rituals, whereas other foods may be viewed as part of the healing process. For example, some cultures do not eat pork because it is considered unclean, and others eat “kosher” food that prescribes how food is prepared. Some religions fast during religious holidays from sunrise to sunset, where others avoid eating meat during the time of Lent. [62] , [63]
Read more about the impact of religious and cultural beliefs on food intake in the “ Spirituality ” chapter of this book.
Economic Resources
If a patient has inadequate financial resources, food security and food choices are often greatly impacted. Healthy, nutrient-dense, fresh foods typically cost more than prepackaged, heavily processed foods. Poor economic status is correlated with the consumption of calorie-dense, nutrient-poor food choices, putting these individuals at risk for inadequate nutrition and obesity. [64] Social programs such as Meals on Wheels, free or reduced-cost school breakfast and lunch programs, and government subsidies based on income help reduce food insecurity and promote the consumption of healthy, nutrient-dense foods. Nurses refer at-risk patients to social workers and case managers for assistance in applying for these social programs.
Drug and Nutrient Interactions
Some prescription drugs affect nutrient absorption. For example, some medications such as proton pump inhibitors (omeprazole) alter the pH of stomach acid, resulting in poor absorption of nutrients. Other medications, such as opioids, often decrease a person’s appetite or cause nausea, resulting in decreased calorie and nutrient intake.
Surgery
Surgery can affect a patient’s nutritional status due to several factors. Food and drink are typically withheld for a period of time prior to surgery to prevent aspiration of fluid into the lungs during anesthesia. Anesthesia and pain medication used during surgery slow peristalsis, and it often takes time to return to normal. Slow peristalsis can cause nausea, vomiting, and constipation. Until the patient is able to pass gas and bowel sounds return, the patient is typically ordered to have nothing by mouth (NPO). If a patient experiences prolonged NPO status, such as after significant abdominal surgery, intravenous fluids and nutrition may be required.
Surgery also stimulates the physiological stress response and increases metabolic demands, causing the need for increased calories. The stress response can also cause elevated blood glucose levels due to the release of corticosteroids, even if the patient has not been previously diagnosed with diabetes mellitus. For this reason, nurses often monitor post-op patients’ bedside blood glucose levels carefully.
Bowel resection surgery in particular has a negative impact on nutrient absorption. Because all or parts of the intestine are removed, there is decreased absorption of nutrients, which can result in nutrient deficiencies. Many patients who have experienced bowel resection require nutrient supplementation.
Bariatric surgery is used to treat obesity and reduce obesity-related cardiovascular risk factors. Bariatric procedures alter the anatomy and physiology of the gastrointestinal tract, which makes patients susceptible to nutritional deficiencies. [65] Read more about bariatric surgery and long-term nutritional issues using the hyperlink in the following box.
Altered Metabolic States
Metabolic demands impact nutrient intake. In conditions where metabolic demands are increased, such as during growth spurts in childhood or adolescence, nutritional intake should be increased. Disease states, such as cancer, hyperthyroidism, and AIDS, can increase metabolism and require an increased amount of nutrients. However, cancer treatment, such as radiation and chemotherapy, often causes nausea, vomiting, and decreased appetite, making it difficult for patients to obtain adequate nutrients at a time when they are needed in high amounts due to increased metabolic demand.
Other diseases like diabetes mellitus cause complications with nutrient absorption due to insulin. Insulin is necessary for the metabolism of fats, proteins, and carbohydrates, but in patients with diabetes mellitus, insulin production is insufficient or their body is not able to effectively use circulating insulin. This lack of insulin can result in impaired nutrient metabolism.
Alcohol and Drug Abuse
Alcohol and drug abuse can affect nutritional status. Alcohol is calorie-dense and nutrient-poor. With alcohol use, the consumption of water, food, and other nutrients often decreases as patients “drink their calories.” This may result in decreased protein intake and body protein deficiency. Nutrient digestion and absorption can also decrease with alcohol consumption if the stomach lining becomes eroded or scarred. This can cause hemoglobin, hematocrit, albumin, folate, thiamine, vitamin B12, and vitamin C deficiencies, as well as decreased calcium, magnesium, and phosphorus levels. [67]
Drug abuse of stimulants, such as methamphetamine and cocaine abuse, causes an increased metabolic rate and decreased appetite and contributes to weight loss and malnourishment.
Psychological State
Various psychological states have a direct effect on appetite and a patient’s desire to eat. Acute and chronic stress stimulates the hypothalamus and increases production of glucocorticoids and glucose. This can increase the person’s appetite, causing increased calorie intake, fat storage, and subsequent weight gain. When a person feels stressed, their food choices are often nutrient-poor and calorie-dense, which further increases weight gain and nutrient deficiencies. In other individuals, the stress response causes loss of appetite, weight loss, and nutrient deficiencies. [68]
Depression can cause loss of appetite or overeating.  Additionally, many antidepressants can cause weight gain as a side effect.
- This work is a derivative of Anatomy and Physiology by Boundless and is licensed under CC BY-SA 4.0 ↵
- This work is a derivative of Anatomy and Physiology by Boundless and is licensed under CC BY-SA 4.0 ↵
- “ Digestive-41529_1280.png ” by Sarahguess5 is licensed under CC0 ↵
- Human digestive system. (2019). In Britannica. Gastrointestinal tract as an organ of immunity. https://www.britannica.com/science/human-digestive-system/The-gastrointestinal-tract-as-an-organ-of-immunity ↵
- Youdim, A. (2019, May). Overview of nutrition . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/nutrition-general-considerations/overview-of-nutrition ↵
- Youdim, A. (2019, May). Overview of nutrition . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/nutrition-general-considerations/overview-of-nutrition ↵
- Youdim, A. (2019, May). Overview of nutrition . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/nutrition-general-considerations/overview-of-nutrition ↵
- Youdim, A. (2019, May). Overview of nutrition . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/nutrition-general-considerations/overview-of-nutrition ↵
- “Eat-Foods-Low-on-the-Glycemic-Index-Step-1-Version-2.jpg” by unknown is licensed under CC BY-NC-SA 3.0 . Access for free at https://www.wikihow.com/Eat-Foods-Low-on-the-Glycemic-Index#aiinfo ↵
- Youdim, A. (2019, May). Overview of nutrition . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/nutrition-general-considerations/overview-of-nutrition ↵
- Brazier, Y. (2020, December 10). How much protein does a person need? Medical News Today . https://www.medicalnewstoday.com/articles/196279 ↵
- “ Protein-rich_Foods.jpg ” by Smastronardo is licensed under CC BY-SA 4.0 ↵
- Youdim, A. (2019, May). Overview of nutrition . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/nutrition-general-considerations/overview-of-nutrition ↵
- Healthwise. (2020, December 17). Types of fats . Michigan Medicine at University of Michigan. https://www.uofmhealth.org/health-library/aa160619 ↵
- Healthwise. (2020, December 17). Types of fats. Michigan Medicine at University of Michigan. https://www.uofmhealth.org/health-library/aa160619 ↵
- Johnson, L. E. (2020, November). Overview of vitamins . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency,-dependency,-and-toxicity/overview-of-vitamins?redirectid=43#v2089966 ↵
- Johnson, L. E. (2020, November). Overview of vitamins . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency,-dependency,-and-toxicity/overview-of-vitamins?redirectid=43#v2089966 ↵
- Healthwise. (2020, December 17). Vitamins: Their functions and sources . Michigan Medicine at University of Michigan. https://www.uofmhealth.org/health-library/ta3868 ↵
- Healthwise. (2020, December 17). Vitamins: Their functions and sources . Michigan Medicine at University of Michigan. https://www.uofmhealth.org/health-library/ta3868 ↵
- Healthwise. (2020, December 17). Vitamins: Their functions and sources . Michigan Medicine at University of Michigan. https://www.uofmhealth.org/health-library/ta3868 ↵
- Johnson, L. E. (2020, November). Folate deficiency . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/folate-deficiency ↵
- Johnson, L. E. (2020, November). Niacin deficiency . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/niacin-deficiency ↵
- Johnson, L. E. (2020, November). Riboflavin deficiency . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/riboflavin-deficiency ↵
- Johnson, L. E. (2020, November). Thiamin deficiency . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/thiamin-deficiency ↵
- Johnson, L. E. (2020, November). Vitamin B6 deficiency and dependency. Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-b6-deficiency-and-dependency ↵
- Johnson, L. E. (2020, November). Vitamin B12 deficiency . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-b12-deficiency ↵
- Johnson, L. E. (2020, November). Vitamin C deficiency . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c-deficiency ↵
- Healthwise. (2020, December 17). Vitamins: Their functions and sources . Michigan Medicine at University of Michigan. https://www.uofmhealth.org/health-library/ta3868 ↵
- Healthwise. (2020, December 17). Vitamins: Their functions and sources . Michigan Medicine at University of Michigan. https://www.uofmhealth.org/health-library/ta3868 ↵
- Healthwise. (2020, December 17). Vitamins: Their functions and sources . Michigan Medicine at University of Michigan. https://www.uofmhealth.org/health-library/ta3868 ↵
- Johnson, L. E. (2020, November). Vitamin A deficiency . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-a-deficiency ↵
- Johnson, L. E. (2020, November). Vitamin D deficiency and dependency . Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-d-deficiency-and-dependency ↵
- Johnson, L. E. (2020, November). Vitamin D toxicity. Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-d-toxicity ↵
- Johnson, L. E. (2020, November). Vitamin E deficiency. Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-e-deficienc y ↵
- Johnson, L. E. (2020, November). Vitamin E toxicity. Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-e-toxicity ↵
- Johnson, L. E. (2020, November). Vitamin K deficiency. Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-k-deficiency ↵
- Johnson, L. E. (2020, November). Vitamin K toxicity. Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-k-toxicity ↵
- MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2020, Oct 19]. Minerals; [reviewed 2015, Apr 2; cited 2021, Mar 5]. https://medlineplus.gov/minerals.html ↵
- Texas Heart Institute. (n.d.). Minerals: What they do, where to get them. https://www.texasheart.org/heart-health/heart-information-center/topics/minerals-what-they-do-where-to-get-them/ ↵
- Texas Heart Institute. (n.d.) Trace elements: What they do and where they get them. https://www.texasheart.org/heart-health/heart-information-center/topics/trace-elements/ ↵
- Texas Heart Institute. (n.d.). Minerals: What they do, where to get them. https://www.texasheart.org/heart-health/heart-information-center/topics/minerals-what-they-do-where-to-get-them/ ↵
- Texas Heart Institute. (n.d.) Trace elements: What they do and where they get them. https://www.texasheart.org/heart-health/heart-information-center/topics/trace-elements/ ↵
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020-2025 (9th ed.). https://www.dietaryguidelines.gov/ ↵
- “ MyPlate_blue.png ” by USDA is licensed under CC0 ↵
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020-2025 (9th ed.). https://www.dietaryguidelines.gov/ ↵
- USDA MyPlate. (n.d.). What’s on your plate? U.S. Department of Agriculture. https://www.myplate.gov/ ↵
- “ MyPlate_blue.png ” by USDA is licensed under CC0 ↵
- “ MyPlate_Vietnamese.png ” by USDA is licensed under CC0 ↵
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020-2025 (9th ed.). https://www.dietaryguidelines.gov/ ↵
- “ Food-healthy-vegetables-potatoes_(23958160949).jpg ” by www.Pixel.la Free Stock Photos is licensed under CC0 ↵
- “ front_en.3.400.jpg ” by openfoodfacts-contributors is licensed under CC BY-SA 3.0 ↵
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020-2025 (9th ed.). https://www.dietaryguidelines.gov/ ↵
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020-2025 (9th ed.). https://www.dietaryguidelines.gov/ ↵
- “ Culinary_fruits_cropped_top_view.jpg ” by Bill Ebbesen is licensed under CC BY 3.0 ↵
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020-2025 (9th ed.). https://www.dietaryguidelines.gov/ ↵
- “ Good_Dairy_Sources.png ” by Brookepinsent is licensed under CC BY-SA 4.0 ↵
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020-2025 (9th ed.). https://www.dietaryguidelines.gov/ ↵
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020-2025 (9th ed.). https://www.dietaryguidelines.gov/ ↵
- “ Hypothalamus.jpg ” by Methoxyroxy~commonswiki is in the Public Domain ↵
- Human Nutrition by University of Hawai’i at Mānoa Food Science and Human Nutrition Program is licensed under CC BY 4.0 ↵
- Human Nutrition by University of Hawai’i at Mānoa Food Science and Human Nutrition Program is licensed under CC BY 4.0 ↵
- Dindyal, S., & Dindyal, S. (n.d.). How personal factors, including culture and ethnicity, affect the choices and selection of food we make. Internet Scientific Publications, 1 (3). https://ispub.com/IJTWM/1/2/11779 ↵
- Stewardship. (n.d.). What is Lent? When does Lent start? What to do during Lent? https://40acts.org.uk/about/what-is-lent/?__cf_chl_jschl_tk__=ef2ed5d0d141e0ea2b579938aca20e0e943f1c75-1614133089-0-AWdOUzF-oUz7XgHuq9pRLnxaEUF5qIJeJYQwB4UPNFLdq498NOv0E_PhRZ_-2Fnlf-j-ar1ifd4YLDpre2QBuuMl6Kl_tI7wGUp8CiI7_K28S-RBVgOp_30ChPVHXqS1_FCgntbnR8yj7TPb8Lsz1iTpbD5KCZVxOJeTw_f03LYD_DB7gZN0Tbsv-r4EQkXEP-Bvgf3rX_uyNNxXfEUvXiZ88b1uD4Dh3ltPLjc9ZxmBCkQS36pkRU7iIu4eRVTfbRON5zBGmxuiriWsRqM5l9aP_yNAkL-0SZhbMtAJOR34IHilovA68VFHPP6au-681TyrxjlJd1IlSzsH1nf7TfU ↵
- Alkerwi, A., Vernier, C., Sauvageot, N., Crichton, G., & Elias, M. (2015). Demographic and socioeconomic disparity in nutrition: Application of a novel correlated component regression approach. BMJ Open, 5 (5). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431064/ ↵
- Lupoli, R., Lembo, E., et al. (2017) Bariatric surgery and long-term nutritional issues. World Journal of Diabetes , 8 (11), 464-474. DOI: 10.4239/wjd.v8.i11.464 ↵
- Lupoli, R., Lembo, E., et al. (2017) Bariatric surgery and long-term nutritional issues. World Journal of Diabetes , 8 (11), 464-474. DOI: 10.4239/wjd.v8.i11.464 ↵
- Gramlich, L., Tandon, P., & Rahman, A. (2019). Nutritional status in patients with sustained heavy alcohol use. UpToDate. Retrieved February 21, 2021, from https://www.uptodate.com/contents/nutritional-status-in-patients-with-sustained-heavy-alcohol-use?csi=5c4a69dc-6adc-4ae0-a572-4be3ef0e325f&source= contentShar e ↵
- Ulrich-Lai, Y. M., Fulton, S., Wilson, M., Petrovich, G., & Rinaman, L. (2015). Stress exposure, food intake and emotional state. Stress (Amsterdam, Netherlands), 18 (4), 381–399. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843770 / ↵


5.12.1: Review Questions
-
- Last updated
- Save as PDF
Review Questions
1 .
One goal of Healthy People 2030 is to improve pregnancy planning and prevent unintended pregnancy. What is a negative outcome related to unintended pregnancy that is related to this HP goal?
-
lost jobs related to inabilities to continue to work
-
depression and anxiety
-
increased BMI and unintentional weight gain
-
increased health-care costs in the United States
2 .
When the nurse is assisting a person desiring contraception, a history and physical is done. What is an important question the nurse should ask?
-
What is your education level?
-
Have you ever been pregnant?
-
Are you married?
-
What is your exercise routine?
3 .
The nurse assesses a patient for medical eligibility for contraceptive use. What is the meaning of an MEC score of 1?
-
There is no restriction for the use of the contraceptive method.
-
There is an unacceptable health risk if the contraceptive method is used.
-
There is a risk that outweighs the advantages of the contraceptive method.
-
There is an advantage of using a contraceptive method that outweighs any risk.
4 .
The nurse assesses a patient for medical eligibility for contraceptive use. What is the meaning of an MEC score of 2?
-
There is no restriction for the use of the contraceptive method.
-
There is an unacceptable health risk if the contraceptive method is used.
-
There is a risk that outweighs the advantages of the contraceptive method.
-
There is an advantage of using a contraceptive method that outweighs any risk.
5 .
When evaluating cervical mucus, what is the quality of spinnbarkeit?
-
elasticity
-
amount
-
clarity
-
color
6 .
A patient would like to use the calendar method for contraception. She has charted her menstrual cycles for several months. Her longest menstrual cycle was 39 days long, and her shortest period was 29 days long. The nurse educates the patient to avoid condomless intercourse during what range of days of the cycle?
-
day 9 through day 19
-
day 10 through day 15
-
day 12 through day 16
-
day 11 through day 28
7 .
Why would FAM not be appropriate for the nurse to recommend to a perimenopausal person?
-
At that age, people do not have intercourse on a regular basis.
-
They are married and do not need contraception.
-
They have irregular menstrual periods.
-
Pregnancy is not a concern when a person is perimenopausal.
8 .
A patient asks the nurse about using the basal body temperature method as contraception. What statement made by the patient indicates that the patient needs further teaching?
-
“I need to take my temperature before I even sit up in bed.”
-
“A rise of 0.4° F above my baseline temperatures for 3 days indicates it is safe to have condomless sex.”
-
“I need to use a special thermometer to take my basal body temperature.”
-
“I know I am about to ovulate when my temperature rises at least 0.4° F.”
9 .
The nurse provides counseling on coitus interruptus. What important counseling should be included?
-
The partners must communicate well to use this method.
-
This method is 100 percent effective because semen does not enter the vagina.
-
BBT must be used with this method.
-
All persons are able to control ejaculate in time to withdraw.
10 .
What is contraceptive abstinence?
-
mutual masturbation
-
individual masturbation
-
oral stimulation of the genitals
-
avoiding penis-in-vagina intercourse
11 .
What is an advantage of the cervical cap over the diaphragm?
-
a lower failure rate
-
its ease of insertion
-
that it can remain in place for 48 hours
-
that spermicide is not needed
12 .
What is an advantage of the internal condom?
-
It can be used by those who have a latex allergy.
-
It can be used for repeated acts of intercourse.
-
It has a lower failure rate than external condoms.
-
It can be used for pleasure purposes.
13 .
A patient calls and says she used her diaphragm on Saturday night at 8:00 p.m., again on Sunday morning at 2:00 a.m., and again at 8:00 a.m. She is wondering when she can safely remove it while still having effective contraception. What is the nurse’s best response?
-
10:00 a.m. Sunday
-
2:00 p.m. Sunday
-
10:00 p.m. Sunday
-
8:00 a.m. Monday
14 .
What must instructions for use of nonoxynol-9 spermicide include?
-
Nononxynol-9 used with barrier methods increases their efficacy.
-
When spermicide is used with condoms, it will further decrease the risk of STIs.
-
Remove excess spermicide from the vagina within 6 hours to reduce vaginal irritation.
-
Place the spermicide close to the opening of the vagina for maximal effectiveness.
15 .
A patient has had four vaginal deliveries. What barrier contraceptive method’s efficacy is affected by this history?
-
internal condom
-
external condom
-
cervical cap
-
contraceptive gel
16 .
How does estrogen work in COC pills?
-
inhibits ovulation through suppression of LH hormone
-
provides most of the contraceptive effect of the COC
-
stabilizes the endometrium for less unscheduled bleeding
-
inhibits sperm penetration by thickening cervical mucus
17 .
Which is a disadvantage of the progesterone-only contraception pill?
-
Side effects could be increased for persons who are underweight.
-
There could be a decrease in bone mineral density over time.
-
They may cause irregular bleeding and spotting.
-
Return to fertility after discontinuing the pill may take several months.
18 .
An adolescent patient calls the office and asks to speak with the nurse. The patient cannot remember where she can place her contraceptive patch. What area of the body should the nurse tell her to avoid?
-
breasts
-
abdomen
-
buttocks
-
arm
19 .
The nurse is discussing contraceptive options with a patient who states they want to become pregnant in 1 year. Which contraception choice would be appropriate for them? Select all that apply.
- progestin-only contraceptive injections like DMPA
- progestin-only oral contraceptive pills
- fertility awareness methods
- COCs
20 .
The patient asks the nurse when her Nexplanon can be inserted. How does the nurse respond?
-
after the delivery of your placenta
-
only during your period
-
while you are in labor
-
during the delivery
21 .
A patient who has an LNG-IUC in place calls the office and states she just took a pregnancy test, and it is positive. She comes in for a visit, and the nurse does another pregnancy test, which is positive. What does the nurse know that the clinician will inform the patient regarding the IUC?
-
Removing the IUC may increase the chance of infertility.
-
The fetus is at risk for congenital defects.
-
The IUC needs to be removed regardless of the plans for this pregnancy.
-
There is no risk to the fetus if the IUC is left in place.
22 .
What is the LNG-IUC mechanism of action?
-
disruption of fertilization of the egg and sperm
-
termination of a pregnancy
-
creation of a hostile uterine environment
-
thickening cervical mucus, atrophic endometrium
23 .
What is one difference between the copper IUC and the LNG-IUC?
-
efficacy
-
placement in the uterus
-
presence of a normal period
-
shape
24 .
What education does the nurse provide to a person taking Ella for emergency contraception?
-
abstain from sex or use a barrier method for 5 days and then restart their COCs
-
abstain from sex or use a barrier method until their menses occur and then restart their COCs
-
restart their COCs the next day; no backup method is needed
-
restart their COCs the next day and use a backup method for 7 days
25 .
A patient calls the clinic Monday morning. She had condomless sex Friday night and is interested in emergency contraception. What should the nurse tell this patient?
-
Emergency contraception pills are very effective for medically induced abortions early in pregnancy.
-
If she is not midcycle when she had sex, she does not need emergency contraception.
-
It is too late for her to use emergency contraceptive pills, but she can come in for placement of a copper IUD.
-
She can use emergency contraceptive pills, even if she has had other condomless sex since the Friday night event.
26 .
What emergency contraception has the best efficacy for prevention of pregnancy?
-
Plan B
-
Yuzpe
-
copper IUC
-
progesterone-only EC
27 .
The nurse provides education regarding female sterilization. What important information is provided?
-
“You will need to wait 3 months before you are sterile.”
-
“You can have this procedure in the hospital after you give birth.”
-
“Fertilization will affect your milk supply for breast-feeding.”
-
“Tubal ligation is reversible.”
28 .
The nurse provides education regarding male sterilization. What important information is provided?
-
“Many people have vasectomies reversed.”
-
“You will need to return to the office to check for sperm in your ejaculate.”
-
“You will be sterile after 3 months.”
-
“Vasectomy consent forms must have both partners’ consent.”
29 .
The nurse is providing education on a medical abortion. How would she describe the action of the medications?
-
Medications thicken the lining of the uterus and decrease uterine contractions.
-
Medications stop the fetal heart and induce contractions.
-
Medications soften the cervix, cause uterine lining necrosis, and induce contractions.
-
Medications thicken the cervix and the uterine lining.
30 .
The nurse provides education to the person undergoing a surgical abortion. What response by the person shows an understanding of the education?
-
“It’s good I won’t have any pain after the procedure.”
-
“I think I’m sure about my decision.”
-
“I should call if I soak a pad in 2 hours.”
-
“I should follow up for contraception counseling at my annual exam in 6 months.”
31 .
A nurse is giving post-op teaching to a person after a surgical abortion. What education should be provided?
-
Report bleeding that is heavy, soaks more than two pads per hour for 2 hours.
-
You can resume vaginal coitus the next day.
-
You do not need to return to the clinic for follow-up.
-
You should use tampons if your bleeding is heavy.