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Certified Lactation Consultant Exam Questions with Complete Solutions 2023 1.The World Health Organization and UNICEF have set out three strategies needed for increasing breastfeeding initiation and duration in every country. What are the 3 strategies?: Breastfeeding Promotion 2.Focuses on advantages of breastfeeding on a personal (personal connection), community, country (amount spent on healthcare), or global level(waste from formula & formula products) Focuses on the good "advantages" of breastfeeding: Breastfeeding Promotion 3.Focuses on government, manufacturer, and social responsibility to assure breast feeding's ability to compete with commercial interests. Includes addressing improper marketing practices Addressing breastfeeding in public, at work, jury duty, family law, mothers in prison, etc..: Breastfeeding Protection 4.Focuses on the interaction of "helpers" with family as well as program development and implementation: Breastfeeding Support
5. Women how do not breastfeed are at a greater risk for what diseases?: - Myocardial infarction Metabolic syndrome Coronary artery disease Stroke DMI I HTN Hyperlipidemia Cardiovascular disease Breast, endometrial, and ovarian cancer 6.Reason #1 why women do not exclusively breastfeed: Unrealistic expectations from society about motherhood. Along with lack of preparation for what thenewborn period would be like. 7.Reason #2 why women do not exclusively breastfeed: Lack of timely interventions. Mother's problems at 3-7 days posed the greatest risk for stopping whichis when they are home from the hospital and alone with no support. The fastest drop-off is in the first 10 days following discharge from the hospital 1 / 12
breastfeeding, which in turn was leading to a dramatic increase in maternal and infant morbidity and mortality. 9.What does "The Code" do?: Regulates the marketing of breast milk substitutes which includes infant formulas and any other food or drink, together with feeding bottles, and teats, intended for babies and young children. Sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries. Aims to make sure that parental choices on feeding are based on full, impartial information, rather than misleading, inaccurate or biased marketing claims. 10.The Global Strategy for Infant & Young Child Feeding: Is intended as a guide for action; it identifies interventions with a proven positive impact, it empha- sizes providing mothers and families the support they need to carry out their crucial roles, and it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties. 11.What contributes to low rates of exclusive breastfeeding globally?: Care- giver and societal beliefs favoring mixed feedings (believing that breast milk is not enough or that babies actions/issues are related to the breast milk/breastfeeding) Hospital and healthcare practices and policies that are not supportive of breast- feeding Lack of adequate skilled support Aggressive promotion of infant formula and other breast milk substitutes rather than promoting support for breastfeeding Inadequate maternity and paternity leave legislation and other workplace policies Lack of knowledge about the dangers of not exclusively breastfeeding and of proper breastfeeding techniques 12.How to support exclusive breastfeeding: Increase hospital and health system capacity including revitalizing, expanding, and institutionalizing the baby-friendly hospital initiative in health systems Provide community based strategies including communication campaigns tailored to the local context Strengthen the monitoring, enforcement, and legislation related to "The Code" and subsequent resolutions. Enact at least 6 months paid maternity leave Invest in training and capacity building in breastfeeding protection, promotion, and support 13.What is the role of the pituitary glade in milk making?: Messages from 2 / 12
- 1 breast or 2?: There is no difference in baby's net fat intake according to the number of breasts suckled per feeding or the breastfeeding frequency Offer the 1st breast 1st and the 2nd breast 2nd it really doesn't matter 1 breast or 2 whatever they want 25.Lactogenesis 1/Secretory Differentiation: Production of colostrum from the placental hormones (progesterone) When placenta delivers the progesterone levels drop to allow for prolactin to take its place in the milk making cells 26.Lactogenesis 2/Secretory Activation: Begins when progesterone leaves the cells and prolactin enters the receptor sites Milk will be a mix of colostrum and mature milk 27.Lactogenesis 3/Galactopoesis: Long term production of mature milk Need frequent removal of milk and frequent nipple stimulation to continuously produce milk 28.How does pH of the gut effect babies: Gut pH of breastfed babies is higher than those who are formula fed or even mixed fed. Higher pH means less harmful bacteria is able to grow which helps have less issues with diarrhea 29.How does iron effect baby's gut: Low iron in the gut is good, breastmilk has relativly low iron content Tons of different bacteria thrives on excess iron so having to much can cause issues 30.How does the presence of lactobacillus bifidus affect baby's gut: Pres- ence of bifidus factor in breast milk promotes the growth of lactobacillus bifidus which helps maintain the low pH and crowd out the harmful bacteria 31.How does the presence of SIgA antibodies effect baby's gut: Antibodies such as SIgA bind to microbes in the baby's intestinal tract and prevent them from being absorbed into the rest of the body. Mothers IgA has been found to protect against the development of necrotizing enterocolitis in preterm infants 32.Weight loss in breastfed infant: No more than 7% weight loss from with birth weight and no more weight loss by day 5 and should be back to birth weight by 2 weeks Weight loss greater than 7% from birth weight indicates a possible breastfeeding problem and requires more intensive evaluation of 4 / 12
33.What causes infants to lose weight in the first postpartum days: Labor medications More intrapartum fluids are given, they have more fluid to loss which is a normal process No labor prior to a c-section, maybe they weren't ready to be born 34.How do I know my baby is getting enough milk?: One wet diaper for how old the baby is (however this can be skewed by the diuresing process and is not a good indicator of adequate hydration) 4 wets on day 4 and each day after Multiple poops each day that change in consistency and color 35.How much weight should my baby be gaining: Approximently 1 ounce per day is expected in the early months by more may be needed for babies with metabolic or respiratory distress because they tend to burn more calories breathing, keeping warm, etc.. 36.Size of the breast relates to the amount of milk produced: No!! the propor- tion of glandular and fat tissue and the number and size of the ducts are not related to milk production 37.Need to drink a lot of fluids to produce a lot of milk: No!! There is not enough evidence to support increasing fluid intake beyond what breastfeeding mothers are likely to require to meet their needs
38. Maternal exercise is related to infant weight gain growth: No!! 39.Increased worry of stress my diminish milk supply: Not necessarily, wor- ry/stress may alter behavior which could alter supply but not nursing enough or removing milk often enough 40.How do we assure an adequate milk supply?: Universal understanding of how breastfeeding works Early initiation and adequate breastfeeding (10-12x per day) Appropriate breastfeeding assessment Improved and early breastfeeding support Appropriate HCP and LCP follow-up in the postpartum period Admitting there is no magic bullet More nursing= more milk 41.Negative influences on milk production: Long spaced between feedings Long, slow feedings-can effect prolactin production 42.Negative influences on milk production: Excessive pressure in the breast: Pressure on the milk making cells causes less milk to be made 5 / 12
Classification is about function during feeding not about how inverted or flat the nipple looks at rest Does the nipple ever evert? Look over the mothers shoulder to see what the nipple looks like immediately following feeding 47.Negative influences on milk production: Sub-optimal or altered physiol- ogy: Iron deficiency Anemia: Physiologic (poor O2 to milk making cells) or due to exhaustion or depression altering mothers coping behavior Hemorrhage: Sheehan's syndrome (the pituitary gland is deprived of blood and its functions are impaired) Hormone imbalance: Thyroid, obesity, GDM PCOS Certain drugs: Pseudoephdrines & corticosteroids (betamethasone)
48. Smoking and breastfeeding: Smoking mothers make less milk Smoking mothers may have lower prolactin levels because prolactin doesn't rise like it should Babies tended to nap less when fed milk from mothers who smoked vs those who did not smoke Quiting smoking during pregnancy resulted in a lower chance of preterm birth 22% of SIDS cases can be directly attributed to maternal smoking during pregnan- cy 49.Canabis use and breastfeeding: Exposure of infant to any kind of passive smoke is a concern. There is no safe threshold limit for cannabis use in pregnan- cy. Among pregnant women cannabis use was significantly associated with an increased risk of preterm birth and low birth weight The high fat solubility of cannabinoids make them difficult to analyze in breast milk. THC (delta-9-tetrahydrocannabinol) is measurable in milk 6 days after maternal use 50.Anemia and breastfeeding: Postpartum hemorrhage can cause sheehans syndrome which in turn causes hormonal issues including milk making hormones Retained placenta fragments prevents the shift from lactogenesis stage 1 to stage 2 which can affect your mature milk coming in 51.Is nursing during pregnancy safe?: It is safe as long as you are not at risk for preterm delivery, however the composition of your milk might change due to placental hormones being on board and your toddler 7 / 12
Milk volumes increase faster but less engorgement is experienced with two nurslings May require specific teaching to manage faster flow Help parents respond to different needs of each child Nurse newborns frequently Find time for non-nursing interactions with older babies 53.Negative influences on milk production: Physical objects: Pacifier use may be an indicator that parents need extra breastfeeding teaching Ask ques- tions Nipple shields 54.Postpartum depression: Women who are more likely to wean early are those who have experienced depression either in pregnancy or postpartum Among women with breastfeeding difficulties, women who had a negative expe- rience with breastfeeding support had a significantly higher risk of postpartum depression and more likely to show symptoms at 2 months 55.Silence learner: A position of not knowing in which the person feels voiceless, powerless, and mindless Afraid of words See themselves as relatively powerless and dependent on others for survial Do not trust their ability to understand or remember Have little awareness of their intellectual capabilities Live at the behest of those around them To develop a relationship with Women in Silence: Few words Familiar words Short, easy, comfortable Nothing to remember You may need to be an advocate 56.Receivers of knowledge: Believe that all authorities tell the truth Like to learn the right answer and repeat it to the teacher Can not tolerate ambiguity Submit to the command of authority-not inner voice 8 / 12
59.Constructed Knowing: The position at which truth is understood to be con- textual, knowledge is tentative, and it is understood that the knower is part of the known Have abandoned either/or thinking Have learned to live with conflict and have high tolerance for internal contradiction and ambiguity Believe all knowledge is constructed and the knower is an intimate part of the known Want to avoid compartmentalizing thought and feeling, home and work, self and other Want to embrace all the pieces of the self in some ultimate sense of the whole: mother-daughter-wife-artist Aspire to work that contributes to the empowerment and improvement in the quality of life of others Believe that ideas and values must be nurtured Have a unique and authentic voice 60.Storing fresh expressed or pumped breast milk: Up to 4 hours on the countertop Up to 4 days in the refrigerator Within 6 months but up to 12 months in the freezer 61.Storing thawed, previously frozen breast milk: Up to 1-2 hours on the countertop Up to 24 hours in the refrigerator Never re-freeze previously thawed milk 62.Storing breast milk that is leftover from a feeding: Use within 2 hours after the baby is done feeding 63.Formula preparation and storing: Formula needs to be mix with water that is at least 70ºC or 158ºF in order to kill Enerobacter Sakazakii Formula made with hot water need to be cooled quickly to body temperature if it is being fed to the baby immediately If the formula is not being fed immediately, refrigerate it right away and keep refrigerated until feeling
64. Hierarchy of infant feeding choices: 1. Baby at mothers breast 65.Mother's own expressed milk 66.Milk from a milk bank 67.Cows milk forumla 68.Soy formula 10 / 12
65.Colic: An easily identifiable childhood problem that has no clearly identified treatment Does not seem to be associated with GERD Colicky babies had more than double the abundance of microbia in the gut
66. How much milk do moms make on average?: 750-1000mL per day 67.If baby is diagnosed with Galactosemia: recessive genetic disorder; charac- terized by body's inability to tolerate galactose Can be rapidly fatal is lactose is not completely removed from the infants diet Breastfeeding is contraindicated 68.If mother is infected with HIV: Breastfeeding or feeding at the breast is not advisable 69.If mother is infected with T-cell lymphotopic virus: Breastfeeding or feeding at the breast is not advisable 70.If mother is using illicit street drugs such as PCP or cocaine: Breastfeed- ing or feeding at the breast is not advisable Exceptions being narcotic dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection 71.If mother is suspected or confirmed of having Ebola: Breastfeeding or feeding at the breast is not advisable 72.If mother is infected with untreated brucellosis: Mothers should temporarily not breastfeed or feed expressed breast milk 73.If mother is taking certain medications (medications and decrease cells proliferation: cancer drugs): Mothers should temporarily not breastfeed or feed expressed breast milk 74. If mother is undergoing diagnostic imaging with radiopharmaceuticals: - Mothers should temporarily not breastfeed of feed expressed breast milk 75.If mother has an active herpes lesion on the breast: Can breastfeed from unaffected side if affected side is completely covered If both sides are affected mother should temporarily not breastfeed or feed ex- pressed breastmilk 76.If mother has active TB: Mother should temporarily not breastfeed but can feed expressed breast milk 77.If mother has active chicken pox that developed within the 5 days prior 11 / 12
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