Breastfeeding Challenges and Best Practices, Exams of Nursing

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CLC PRACTICE EXAM (PRACTICE EXAM 1- 9) COMPILATION ACTUAL EXAM 150 QUESTIONS

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What is the most variable constituent of human milk, changing both within a single feed and daily? a) Cholesterol b) Lactose c) Calcium d) Fat - correct answer d) Fat A research study shows that mothers who supplement their babies tend to breastfeed longer than those who don't supplement. Which of the following is most important to know in analyzing such a study? a) Who funded the study b) The authors' definition of breastfeeding c) The authors' definition of supplementation d) The socio-economic of the study participants - correct answer c) The authors' definition of supplementation Which of the following publications is likely to be most useful when considering which drugs are compatible with breastfeeding? a) The Drugs and Lactation Database (LactMed) updated monthly b) Studies published in peer reviewed journals in the last 7 years c) The drug insert that comes with each medication d) Drug information published every year in the Physician's Desk Reference (PDR) - correct answer a) The Drugs and Lactation Database (LactMed) updated monthly The best time for a baby to go to the breast for his first feed is: a) Right after birth b) Within the first six hours of birth

c) As soon as the mother states she is ready d) When the baby demonstrates feeding cues - correct answer d) When the baby demonstrates feeding cues How does the growth pattern of the breastfed infant differ from the formula-fed infant? a) The breastfed newborn gains more slowly at all points in time than a formula-fed infant b) After an accelerated growth in the early months the breastfed baby slows at about 4 months c) The formula-fed infant grows in length faster than the breastfed baby in the first 6 months d) The breastfed infant has a larger head circumference than the formula-fed infant - correct answer b) After an accelerated growth in the early months the breastfed baby slows at about 4 months The LEAST important reason for accurate documentation is: a) To defend yourself in case of a lawsuit b) To provide parents with an individualized plan of care c) To assure the primary HCP has an accurate record of all intervention and suggestions d) To fulfill the requirements of the Standards of Practice for lactation consultants - correct answer b) To provide parents with an individualized plan of care Which factor is higher in colostrum than in mature milk? a) Fat b) Lactose c) Protein d) Oligosaccharides - correct answer c) Protein A 1-month-old infant who has malaria probably acquired the disease: a) Through breast milk b) Via the placenta during the pregnancy

c) Via exposure to the vaginal secretions at the time of brith d) Via exposure to the anopheles mosquitos - correct answer d) Via exposure to the anopheles mosquito The most common cause of sore nipples is related to: a) Incorrect positioning of the baby at the breast b) Concurrent infection of both mother and baby with yeast c) Feeds lasting longer than 15 minutes on each breast d) Oral abnormalities of the infant such as ankyloglossia - correct answer a) Incorrect positioning of the baby at the breast For a mother to fractionate (lactoengineer) her milk she needs to: a) Pump every 1-1.5 hours b) Use hand expression, not a breast pump c) Have an abundant milk supply d) Use only one collection container - correct answer c) Have an abundant milk supply Which matters the most in regards to which women will attend a breastfeeding class? a) If she has some kind of insurance b) Mother's race or ethnicity c) Middle or higher class income d) Education beyond high school - correct answer a) If she has some kind of insurance A short lingual frenulum is referred to as: a) Labioglossia b) Ankyloglossia c) Retracted tongue d) Labial tongue-tie - correct answer b) Ankyloglossia

According to WHO literature, mastitis is more common in first time breastfeeding mothers. The primary reason for this trend may be that first time mothers are more: a) Stressed about breastfeeding and childcare b) Likely to have latch problems resulting in sore nipples c) Reluctant to call their physicians or seek help d) Prone to infection in general due to fatigue - correct answer b) Likely to have latch problems resulting in sore nipples Georgia asks you how long Mimosa should breastfeed each time. What do you tell her? a) At least 10 minutes on the first side and as long as she wants on the second. b) She doesn't need to breastfeed any longer than about 7 minutes on a side because 90% of the milk is gone by then. c) At least 15 minutes on each breast to make sure the breasts receive equal stimulation d) Until Mimosa stops breastfeeding on the first side, then offer the second. - correct answer d) Until Mimosa stops breastfeeding on the first side, then offer the second Which category of drugs is a breastfeeding mother most likely to take? a) Antibiotics b) Antidepressants c) Analgesics d) Antiemetics - correct answer c) Analgesics The AAP Statement recommends pacifiers for infants in the following situations: a) Whenever the infant is in a prone position b) All infants under 4 weeks of age c) Breastfed infants over 4 weeks of age d) Families with a history of SIDS - correct answer c) Breastfed infants over 4 weeks of age

Which of the following nutritional advice for breastfeeding women is evidence-based? a) Increase caloric intake by 500 calories per day b) Drink enough fluids to satisfy thirst c) Avoid spicy foods as they will affect the baby's digestion d) Drink at least 2, 8 oz. glasses of milk per day - correct answer b) Drink enough fluids to satisfy thirst The birth spacing effects of breastfeeding are most beneficial for: a) Infant well-being b) Lactational amenorrhea c) Maternal recovery from childbirth d) Increasing ovulation - correct answer c) Maternal recovery from childbirth Lactoferrin is a whey protein that is protective against infection through: a) Preventing the bacteria from ingesting fat b) Destabilizing the outer cell membrane of bacteria c) Attaching itself to the bacteria, thus preventing replication d) Increasing the amount of IgA available to the infant - correct answer b) Destabilizing the outer cell membrane of bacteria You are an IBCLC that is due to recertify by exam at your 10 year mark. On your way to the exam site, you are in a car accident which lands you in the hospital for a couple of days, so you miss the exam. Which of the following is your first best course of ethical action? a) Continue to use your IBCLC designation and sign up for the exam the next time it's offered b) Call IBCLC as soon as possible to explain what happened; abide by their directives regarding use of the IBCLC designation c) Stop working as an IBCLC once your certification expires until you are able to retake the exam

d) Continue to work as an IBCLC, but not use the designation until you are able to retake the exam - correct answer b) Call IBCLC as soon as possible to explain what happened; abide by their directives regarding use of the IBCLC designation The volume of milk a mother produces can be affected by: a) A weight loss of 1-2 lbs. per week b) Reduction of caloric intake to 1800 kcal/day c) 10% or more dehydration in the mother d) Short-term nutritional supplementation of the mother - correct answer c) 10% or more dehydration in the mother The recovery of S. Aureus in human milk is most likely to be a result of: a) Not being careful in storing and saving pumped milk b) Reoccurring breast milk stasis c) Mastitis with fever over 102 degrees F d) Allowing pumped milk to sit at room temperature for more than 6 hours - correct answer a) Not being careful in storing and saving pumped milk The most common deterrent to choosing breastfeeding in the U.S. is: a) Breastfeeding will cause nipple pain or injury b) The fear of inadequate milk supply c) Because the mother has to return to work d) Breastfeeding is perceived as interfering with a mother's lifestyle choices - correct answer d) Breastfeeding is perceived as interfering with a mother's lifestyle choices The effects of long-lasting and untreated postpartum depression on the infant may be which of the following? a) Immune system deficiency b) Normal weight gain

c) Lack of affect on the baby d) Increased risk of Chikungunya - correct answer c) Lack of affect on the baby The composition of milk changes during weaning in which of the following ways? a) Increase in sodium and protein concentrations b) Increase in fat and calcium concentrations c) Increase in concentration of lactose d) Increase in water-soluble vitamins - correct answer a) Increase in sodium and protein concentrations When a baby has lost excessive weight in by the second day of life, the first thing to check is: a) How well the baby is breastfeeding b) How much fluid and synthetic oxytocin the mother received in labor c) How many times the baby has voided and stooled the first 24 hours d) The pediatrician's preference for a mode of supplementation - correct answer c) How many times the baby has voided and stooled the first 24 hours One of the advantages of double pumping over single pumping is that double pumping: a) Causes less pain in the nipples b) Is easier for the mother to do c) Decreases the time spent pumping d) Stimulates the breasts equally - correct answer c) Decreases the time spent pumping Which infant is at risk for hypoglycemia? a) One who is exhibiting respiratory distress at birth b) One whose mother was on antiemetics during her pregnancy c) An infant born with Hirschsprung's disease

d) An infant born to a mother with rheumatoid arthritis - correct answer a) One who is exhibiting respiratory distress at birth Salome asks you about giving Oscar vitamin D because she has heard the breast milk is deficient in vitamin D. What should you tell her about the AAP's recommendations? a) All infants need to be supplemented with 400 IU vitamin D per day starting within days of birth b) Only dark skinned exclusively breastfed babies living in a northern climate need to be supplemented with vitamin D c) As long as the baby is exposed to sunlight even if fully dressed for at least 2 hours a week, the baby doesn't need supplementation d) All breastfed infants need to receive at least 200 IU of vitamin D per day starting at 4 months

• correct answer a) All infants need to be supplemented with 400 IU vitamin D per day starting within days of birth Which of the following hormones is essential for complete lobular-alveolar development of the mammary gland? a) Progesterone b) Estrogen c) Prolactin d) TSH - correct answer c) Prolactin Jonie calls you to say her physician has diagnosed her 4-week-old baby Melody as having colic. What is your first response? a) Chances are it's due to something in your diet. You can start by removing all dairy products from your food intake b) Unfortunately many first babies have colic and are terribly fussy. It usually lasts for about 3 months and there isn't much you can do c) It sounds as though Melody is lactose intolerant. You might try some lactose-free formula to see if that helps her

d) I can imagine it's really upsetting to hear your baby crying and see her in so much pain - correct answer d) d) I can imagine it's really upsetting to hear your baby crying and see her in so much pain Which of the following is true about fat stores in the breast? a) Fat stores remain constant within the breast during lactation b) Fat is intermingled with glandular tissue throughout the breast c) Subcutaneous fat is concentrated beneath the areola d) The ratio of fat to glandular tissue during lactation is 4:1 - correct answer b) Fat is intermingled with glandular tissue throughout the breast The following markers in breast milk indicate that lactogenesis 2 is occurring or has occurred: a) Lactoferrin and lysozyme increase b) Sodium increases and lactose decreases c) Concentrations of sodium and total protein have stabilized d) Concentrations of lactose and citrate increase - correct answer d) Concentrations of lactose and citrate increase A feeding tube at the breast is helpful with: a) A baby who is FTT b) A baby with a shallow latch c) A baby whose mother has inverted nipples d) A mother with very sore nipples - correct answer a) A baby who is FTT Casomorphins are active peptides that are derived from: a) The casein component of breast milk b) The whey component of breast milk c) The carbohydrate component of breast milk

d) The fat component of breast milk - correct answer a) The casein component of breast milk Which of the following classification of drugs may inhibit or reduce milk production? a) Analgesics b) Antihistamines c) Galactogogues d) Antepileptics - correct answer b) Antihistamines Mitzi is an IBCLC and she has just been diagnosed with rheumatoid arthritis. When she researches this condition she finds which of the following to be true? a) Rheumatoid arthritis affects over 10% of the adult population b) Rheumatoid arthritis is more common in men than in women c) Epidemiological studies have suggested that gut microbiota are important in the development of rheumatoid arthritis d) Women who breastfeed are less likely to develop rheumatoid arthritis - correct answer d) Women who breastfeed are less likely to develop rheumatoid arthritis The most common component of ritual, prelacteal feeds is: a) Formula b) Fruit c) Honey d) Gruel - correct answer c) Honey A SGA infant should: a) Be expected to gain faster on formula than on breast milk b) Be completely neurologically intact c) Receive sufficient kilocalories to meet the needs of the AGA infant

d) Be able to breastfeed without difficulty - correct answer c) Receive sufficient kilocalories to meet the needs of the AGA infant Darsee wants to develop a pumping plan so she can start storing her breast milk for when she returns to work in 8 weeks. Which statement would be the most helpful? a) I'm lad you are planning ahead. Have you found child care yet? b) It's good that you are thinking about storing your milk ahead of time since it will take a long time to freeze enough milk. c) You are likely to get more milk if you buy a pump that can pump both breasts at the same time. d) One of the best times to pump is once a day during the baby's longest sleep period or whenever she nurses on one side and not the other - correct answer d) One of the best times to pump is once a day during the baby's longest sleep period or whenever she nurses one side and not the other Trelawney is a vegetarian and plans to breastfeed her baby which is due in 2 months. When you review her diet history, you need to be certain of which of the following nutrient is included? a) Calcium b) Vitamin B c) Vitamin C d) Iron - correct answer b) Vitamin B The Innocenti Declaration is a call to action for governments to: a) Encourage a breastfeeding culture b) Encourage breastfeeding education c) Encourage Baby Friendly Hospitals d) Encourage initiation of breastfeeding at birth - correct answer a) Encourage a breastfeeding culture What is a benefit for nursing beyond 12 months?

a) Decreases risk for development of vitamin C deficiency b) Provides significant part of their energy needs c) Prevents plagiocephaly d) Increases infant mental acuity - correct answer b) Provides significant part of their energy needs IV fluids, more than 1200 mL, given to the mother in labor can result in which of the following? a) Increased infant urine output on day 1 resulting in increased weight loss b) Rapid onset of lactogenesis 2 c) Higher risk for an increased bilirubin level in the infant d) An increase in the amount of uric acid crystals excreted through the baby's urine - correct answer a) Increased infant urine output on day 1 resulting in increased weight loss The important work on milk storage capacity and rate milk synthesis of the breast as found by Peter Hartmann indicated, among other things that: a) Storage capacity of the breast can differ between women by up to 300% b) Storage capacity of the breast is fairly constant between women c) Babies gain weight best when on a 3-hour schedule because that assures that the amount of milk stored in the breast is at its peak d) The rate of milk synthesis stays constant regardless of the fullness or emptiness of the breast

• correct answer a) Storage capacity of the breast can differ between women by up to 300% The breast milk composition from a breast with mastitis produces higher levels of: a) Insulin b) Beta-carotene c) Sodium d) Potassium - correct answer c) Sodium Which of the following hormones is present in breast milk?

a) Lactase b) Estrogen c) Parathyroid d) Prolactin - correct answer d) Prolactin Jillian calls and says that when she starts nursing the baby, she often feels a deep depression that is often present during the entire feeding. She wonders what is wrong with her, and you tell her: a) "I'm not sure what is going on. I think you need to see your OB and get treatment. b) "This is something that other mothers have described happening, and is known as Dysmorphic Milk Ejection Reflex (D-MER). Let's talk about it some more." c)"This is one of the symptoms of a variety of postpartum anxiety disorders. It's important that you seek psychological counseling." d) This is related to your flight-or-fight response stimulated by an excess of adrenaline when you start nursing." - correct answer b) "This is something that other mothers have described happening, and is known as Dysmorphic Milk Ejection Reflex (D-MER). Lets talk about it more." If an infant is exhibiting symptoms of lactose overload, which of the following is the most effective technique to decrease the symptoms? a) Use the laid back (biological nursing) position for breastfeeding b) Decrease the amount of lactose in the mother's diet c) Give the baby a higher proportion of hind milk than fore milk d) The mom should take Lactaid capsules before eating dairy products - correct answer c) Give the baby a higher proportion of hind milk than fore milk The best reason to encourage breastfeeding with the mother of a baby with Down Syndrome is: a) These infants may suck poorly b) These infants may have multiple medical problems c) These infants are physically and developmentally delayed d) These infants are prone to infection - correct answer d) These infants are prone to infection

You are discussing allergies in a prenatal breastfeeding class. One of the facts you want to point out is that many of the babies who are allergic to cow's milk protein can also be sensitive to: a) Wheat b) Corn c) Soy d) Eggs - correct answer c) Soy Julie, a first time mom, tells you that her baby was very fussy last night, which was the baby's second night. You know that this is most likely due to: a) Her milk isn't in yet, and the baby is hungry b) She's exhausted and is magnifying the situation c) The mom is uptight and transmitting her nervousness to the baby d) Overwhelming CNS stimulation in the baby - correct answer d) Overwhelming CNS stimulation in the baby Alyssa reports that Ethan falls asleep whenever the nurses bring him to here to breastfeed. Which of the following would be the most helpful advice? a) Room-in with Ethan, watching him for feeding cues b) Wake him by washing his face with a cool, damp cloth c) Make sure the nurses bring him in as soon as he cries d) Coax him to the breast using drops of glucose water on the nipple - correct answer a) Room- in with Ethan, watching him for feeding cues Babies who have early contact with their mothers and who were provided with postpartum support are more likely to: a) Have a faster weight gain than babies who are separated from mom b) Be able to sleep in their own room by one month c) Be breastfed long enough to meet the mother's goals

d) Breastfeed more frequently at night - correct answer d) Breastfeed more frequently at night On the physical exam of a 28-week preterm infant , which of the following is likely to be found? a) Lanugo all over the body b) Dry and peeling skin c) Palpable breast buds d) Ability to coordinate suck, swallow, and breathe - correct answer a) Lanugo all over the body Cherie, a new mother, with a 4-week-old infant, visits you for a breastfeeding evaluation. In the process of taking her history, you find that Cherie eats mostly chips, cookies and soda "because she is just too busy to prepare anything". Your MOST IMPORTANT concern with Cherie's diet is: a) The quality of her breast milk b) The quantity of her breast milk c) The health of the baby d) The depletion of Cherie's nutrient stores - correct answer d) The depletion of Cherie's nutrient stores Halli is now 2-hours-old and still has not shown any interest in nursing. You do a blood sugar test on Halli, and find that it's 38 mg/dL, which is lower than your hospital standard of 40 mg/dL. What should you do first? a) Put her under the warmer as she is most likely hypothermic b) Give her 1 oz. of formula by finger-feeding c) Have mom hand express colostrum and feed her with a spoon d) Wait about 30 seconds and use a second reagent strip to check the glucose - correct answer d) Wait about 30 seconds and use a second reagent strip to check the glucose Mothers with breastfeeding problems may be hesitant to seek help from a professional for the following reason: a) Lack of insurance coverage for lactation services

b) Having to leave her home to seek help c) Stress of having to repeat "her story" to multiple people d) Having problems is in conflict with the image of being a super-mom, which she wants to portray - correct answer d) Having problems is in conflict with the image of being a super- mom, which she wants to portray A type of research that focuses on relationships among variables is called: a) Qualitative b) Quantitative c) Statistically significant d) Randomized controlled trials - correct answer b) Quantitative Nipple erection is induced by which of the following? a) Myoepithelial cells contracting the lactiferous sinuses b) Somatic parasympathetic stimuli c) Autonomic sympathetic stimuli d) Adequate levels of aphrodisiacs - correct answer b) Somatic parasympathetic stimuli Which of the following drug categories are contraindicated for use during breastfeeding? a) Pseudoephedrine b) Oral contraceptives c) Cancer chemotherapeutic agents d) Diuretics - correct answer c) Cancer chemotherapeutic agents You are a nurse who works at St. Beneficial Hospital. You have just delivered preterm twins. A formula representative offers you samples of a new formula, which provides specific nutrients for your low birth weight infants. In what way is this a violation of the International Code of the Marketing of Breast-Milk Substitutes (WHO Code)?

a) This isn't a violation as the WHO Code provides for samples of specialized formulas for low birth weight babies b) The WHO Code states that no personal samples of formula may be given to health care workers c) As an employee of a not-for-profit hospital, you cannot accept gifts from formula companies d) This isn't a violation because you are unable to breastfeed your twins, so accepting formula isn't an issue - correct answer b) The WHO Code states that no personal samples of formula may be given to health care workers Month-old Reuben weighed 7 lbs., 2 oz. at birth. When you weigh him, he is 7 lbs., 4 oz. Helen- Clare says Reuben nurses all the time and never seems satisfied. When you do ac/pc weights, he transfers a total of 37 mL. When Helen-Clare pumps for residual milk, she gets an additional 3 mL. Which suggestion will you make first? a) You need to make sure the feedings are finished within 45 minutes so both of you can get rest b) Reuben needs a supplement, which will provide him with additional calories c) You need to use a nursing supplementer to give Reuben the extra calories he needs and provide some breast stimulation at the same time d) To increase your milk supply, you are going to need to pump with a quality breast pump and take some galactogogues - correct answer b) Reuben needs a supplement, which will provide him with additional calories Infants who have a higher than average number of bowel movements during the first 3 DOL will probably exhibit which of the following: a) Dehydration as evidenced by poor skin turgor b) Later transition to yellow stools c) Higher bilirubin levels on day 5 d) Weight loss greater than 10% on day 4 - correct answer d) Weight loss greater than 10% on day 4 For a mother to have adequate levels of vitamin D in her milk in order to pass at least 400 IU to the baby, she needs to:

a) Use a sun screen of less than SPF 30 when out in the sun b) Have a 25-(OH)-D serum level of at least 58 ng/mL c) Take 400 IU of vitamin D each day of her pregnancy d) Drink 3, 8 oz. glasses of vitamin D fortified milk a day and have fish high in vitamin D 2x/week

• correct answer b) Have a 25-(OH)-D serum level of at least 58 ng/mL A "nursing strike" may occur because of: a) Introduction of solid foods b) Infant no longer has an interest in the breast c) Start of mother's menses d) Mother starts a food reduction program - correct answer c) Start of mother's menses Florence birthed Josh at 32 weeks of gestation. Which of the following would be the first thing to include as a part of her pumping plan? a) Begin expressing within the first hour post-birth b) Determine her nipple size to provide her with the appropriate flange c) Use a hospital grade breast pump d) Pump using a double pumping system - correct answer a) Begin expressing within the first hour post-birth Increased rates of autism spectrum disorders (ASD) are seen in children who: a) Received less than 1 hour of skin-to-skin after birth b) Received formula supplements in the first week of life c) Were formula-fed from the beginning of life d) Were exclusively breastfed for less than 3 months - correct answer c) Were formula-fed from the beginning of life Which of the following statements about lactose in human milk is true?

a) Lactose provides 60% of the calories in human milk b) Lactose is essential for CNS development c) Lactose is decreased in human milk when the mother eliminates dairy d) Lactose concentration decreases from 2-16 weeks - correct answer b) Lactose is essential for CNS development Daisy, who is 21 days postpartum, is seen in the outpatient clinic with burning, painful, red nipples for the last 4 days. Which of the following is most likely to be a cause of her sore nipples? a) Baby has a shallow latch b) Allergic reaction to lanolin c) Her infant is tongue tied d) She has a yeast infection - correct answer d) She has a yeast infection Hope is 3 weeks postpartum and doesn't have enough breast milk. Her history and exam haven't yielded any reason for the low supply. Which test would you want to have done first to possibly provide a reason for low milk supply? a) Thyroid levels b) Iron levels c) Testosterone levels d) Serum prolactin levels - correct answer a) Thyroid levels Josey just delivered 29 week infant, Henry, by c-section because of high blood pressure and increasing amounts of protein in her urine. Which of the following is most likely to contribute to Josey have a low milk supply. a) Josey delivered by c-section b) Josey didn't start pumping until 6 hours after the birth c) Josey's average pumping frequency was 7-8 times per day d) Josey had pre-eclampsia at the time she delivered - correct answer a) Josey delivered by c- section

A potential milk donor may be excluded by the Human Milk Banking Association if the mother: a) Has a 6 oz. glass of wine on a daily basis b) Has been a practicing vegetarian for the last 3 years c) Received a blood transfusion in the past 4 months d) Has had influenza in the previous year - correct answer c) Received a blood transfusion in the past 4 months Which of the following is an important component of the Baby Friendly Hospital Initiative? a) Adhering to the International (WHO) Code b) Following the Bellagio Consensus c) Minimize interventions in labor and delivery d) Providing follow-up for breastfeeding mothers and babies - correct answer d) Providing follow-up for breastfeeding mothers and babies Cheryl calls the lactation hot-line complaining that her milk supply is decreasing. She also says that 4-week-old Ronnie spits up a lot and there appeared to be streaks of blood in his stool earlier in the day. What is your first suggestion? a) Take Ronnie to his pediatrician for an evaluation b) Visit the lactation clinic immediately for an evaluation and feeding assessment c) Have the mother record everything she has eaten in the last 48 hours to determine what food is causing the symptoms d) Tell the mother to eliminate dairy products for 14 days. Then keep a record of Ronnie's spitting and a description of his stools - correct answer a) Take Ronnie to his pediatrician for an evaluation One of the main reasons for the decline of breastfeeding in the 19th century was: a) The belief that formula was scientific and was equated with progress b) Lack of support for nursing mothers by the medical community

c) The though that breast milk composition could only be controlled through controlling women d) Because only poor women breastfed - correct answer a) The belief that formula was scientific and was equated with progress A slow weight gaining infant will: a) Have a decrease in frequency and amount of stool b) Consistently gain weight, but slowly c) Sleep for exceptionally long periods between feedings d) Is more apathetic than an infant with a good weight gain - correct answer b) Consistently gain weight, but slowly Which of the following elements in a woman's history probably will have a negative impact on her breastfeeding success? a) Hypothyroidism treated with thyroid supplements b) Loss of blood during delivery requiring 2 units of blood c) Previous low milk supply treated with use of galactogogues d) No breast changes during pregnancy or within the first month postpartum - correct answer d) No breast changes during pregnancy or within the first month postpartum Marci comes in saying that 21-day-old Jason is very fussy, has lots of gas and at least 8 watery yellow stools per day. He is at his birth weight of 7 lbs., 14 oz. He has a stool while you are examining him that is yellow/green, but without any solid matter.. Which condition would be your first hunch? a) Hyperlactation syndrome b) Cow's milk protein allergy c) Neonatal colitis d) FTT due to insufficient feeds - correct answer a) Hyperlactation syndrome Facilitating is an effective counseling skill because:

a) The mother is allowed to talk b) The mother is encouraged to listen c) The counselor focuses on the mother's specific concern d) The counselor focuses on the mother's feelings - correct answer c) The counselor focuses on the mother's specific concern Which of the following would be most likely to positively impact a mother using a pump correctly? a) Using a pump manufactured from a company that only focuses on breastfeeding b) Reading the direction before using the pump c) Shown how to use from another person, like a friend d) Only use rental pumps - correct answer c) Shown how to use from another person, like a friend You are preparing a list of handouts to use in your breastfeeding class for parents. The most important guidelines you need to consider when selecting your handouts should be: a) Information must be current and consistent b) Handouts should have a 4th grade reading level and lots of white space c) Include information on references for IBCLCs in your community d) Information should include common situations which may occur after the mom is discharged

• correct answer a) Information must be current and consistent Exclusive breastfeeding is more likely to occur if: a) The infant weighed 8 lbs. or more b) Did at least 30 minutes of skin-to-skin after birth c) Wasn't bathed for 4 hours post birth d) Mother who had a c-section did skin-to-skin in the recovery room - correct answer a) The infant weighed 8 lbs. or more

Susan has nipples that are raw and bleeding from nursing her infant who was tongue tied, but who had it revised yesterday. Which of the following would be a good first choice to use with her nipple trauma? a) Tea bags b) Coconut oil c) Saline soaks d) Antibiotic ointment - correct answer c) Coconut oil Milk banks who are members of the Human Milk Banking Association of North America: a) Provide milk to both hospitals and individuals b) Allow selected donors to be paid c) Test donor milk for bacteria d) Sell the milk for a substantial profit - correct answer a) Provide milk to both hospitals and individuals Infants may suddenly collapse while doing skin-to-skin. What can be done to decrease the risk of this happening? a) Mother lying flat with the baby between her breasts b) The baby's head is turned to one side, and is very slightly extended c) Head tilted back so trachea is straight and extremities extended d) Infant's chest is in contact with the mother's body and head is midline - correct answer b) The baby's head is turned to one side, and is very slightly extended When a hospital who was working to become Baby Friendly eliminated pacifier use, what was the outcome? a) Supplemental formula increased from 18-28% b) Breastfeeding challenges decreased by a factor of 10 c) Exclusive breastfeeding rates increased from 68-79%

d) 15% of mothers were sneaking pacifiers into the facility - correct answer a) Supplemental formula increased from 18 - 28% The optimal time interval between pregnancies for a mother is: a) 6-9 months b) 12-15 months c) 24-30 months d) 36-59 months - correct answer d) 36-59 months Rebecca tells you that Tanya, her 3-week-old breastfed infant, has colic. You know that the most common reason for "colic" is: a) Infant isn't being fed enough b) Mother is smoking more than 1/3 pack of cigarettes per day c) Mother has too much breast milk d) A diet that is very high in dairy products - correct answer a) Infant isn't being fed enough Stacey visits you stating her "milk hasn't come in yet". Her baby is 10-days-old and hasn't regained her birth weight. After taking a history, you discover that Stacey continues to have heavy bleeding that contains blood clots. What do you suspect is the reason for the low milk supply? a) Retained placental fragments causing a decrease in prolactin levels b) Retained placental fragments causing estrogen levels to remain high c) Retained placental fragments causing progesterone levels to remain high d) Retained placental fragments causing a drop in the prolactin inhibitory factor (PIF) - correct answer c) Retained placental fragments causing progesterone levels to remain high Krystal Starr is undecided about whether or not to breastfeed her baby because she smokes a pack of cigarettes per day. Which of the following is the most important to discuss with her? a) Unless she can cut down to 15 cigarettes or less per day, she should not breastfeed

b) She should never smoke around the baby, and only after the baby has been fed c) It's not uncommon for babies whose mothers smoke to be more colicky than babies whose mothers don't smoke d) It's far better for the baby's health that a smoking mother breastfeed than formula-feed - correct answer d) It's far better for the baby's health that a smoking mother breastfeed than formula-feed The most beneficial method employers can use to assist mothers to continue breastfeeding after returning to work is: a) Provide a lactation support system b) Provide an electric breast pump c) Provide healthy snacks in pumping room d) Provide a home visit after delivery - correct answer a) Provide a lactation support system Robyn visits the outpatient clinic stating 10-day-old baby, Jeffery, isn't receiving enough milk. You note he latches well, he is positioned appropriately. Jeffery has good body tone and a nice strong, coordinated suck. Upon released from the breast, you see that the nipple is nicely rounded. You do ac/pc weights and you find little milk is transferred. Possible reasons for the poor transfer of milk include which of the following: a) Bilateral breast reduction surgery b) Damage to the 3rd intercostal nerve c) Maternal weight gain of 25 lbs. d) Mother with T2DM - correct answer a) Bilateral breast reduction surgery You are teaching a course in lactation management and Kara, one of the students, asks if a mother has to have a radioactive isotope for which she needs to pump her milk, does she need to dump the milk in every instance. You tell her that: a) Yes, it's important to dump the milk b) That is an excellent question to which no one knows the answer c) Because the antioxidants decrease in milk after 48 hours, it's not recommended that the milk be stored longer than that period of time