CLC Test Module 2 review questions and answers 2025, Exams of Nursing

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What microbiota framework was found to be doubled in colicky babies? - Proteobacteria ( What 5 things negatively effect milk production? - 1. Long spaces between feedings

2. Long, slow feedings
3. Excessive pressure in breast
4. Breast surgery/injury
5. Suboptimal breast anatomy Describe normal full breasts compared to engorged breasts? - Normal: soft to touch, rounder, fuller, firmer, heavier, mother feels well, normal body temp, breast may be hot to attract baby, baby can grasp nipple. Engorged: Hard breast, normal temp, mom is uncomfortable, breast is hot and shiny, nipple is difficult for baby to grasp. What is the best solution for engorged breasts? Breast pump or water? - Water! can allow myoepithelial cells to contract and let milk spurt out. Breast pumping can cause capillaries to errupt because there's so much pressure on the breasts.

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What can cause pressure that leads to engorged breasts? - Secretory activation- lactogenesis II, too much milk left in breast, missed feedings, restrictive bras and clothing, breast implants (less room for milk storage). What are the concerns for breast surgery or injury on milk production? - damage to nerves and/or ducts What should you look for if you suspect breast surgery? - defined area where color changes from areola to breast. If areola is completely round (unusual), if skin tone stands out between areaola to breast (surgery), if it fades, no breast surgery. Describe the nipple graft and how it could negatively impact BF? - Areaola and nipple were completely cut off. This cut connections to ducts, circulatory system, nerves, etc. Nerves may grow back, but we have no way of ensuring. These ducts have been disconnected at one point-not the best for BF. Describe pedicle surgery and how this could effect BF? - Occurs with breast reduction, nipple is still intact, but all other areas around breast are pushed back for reduction, taking out a cup size, then edges are sewn back together. Women with this surgery had a shorter time of exclusive/any breastfeeding compared to controls. Women may be able to breastfeed, but we have no idea until birth when

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What two hormonal issues could be impacted by flat/inverted nipples? - Prolactin- nipple stroking Oxytocin-Nipple stretching Can inverted nipples still produce milk? - Yes, babies have sucked on to mothers neck, it is possible to get inverted nipples to still expand. As long as nipple can elongate and form a "teat" and lower breast tissue can be in babies month, this can occur. Describe the tongue positioning of baby for swallowing and milk flow. - Tongue in up position: swallow, Tongue in down position: nipple stretches and milk flow. When may flat nipples evert, and therefore may not impact BF? - During pregnancy, in postpartum, evert during suckling, other manipulation (sexual stimulation, finger manipulation, cold) Describe the 3 grades of nipple classification? - Grade 1: easily pulled out with breastpump/nursing baby Grade 2: can be pulled out but don't maintain their projection

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Grade 3: Difficult/impossible to pull out How do we grade inverted nipples - Grade these by standing over mother's should and watch when she takes baby off the breast. Classify based on it's change during feeding, not how they look at rest. Grade 1 & 2 (would go back in rapidly!) Grade 3: before and after are the same. (can wonder if ducts are shorter/are there other anatomical issues? Will not know grade until baby is born and tries to feed. Does the Hoffman technique/prenatal nipple preparation improve inverted nipples? - Nope! Research shows that women who did not do the Hoffman technique (stroking lightly around nipple) had better success at nipple eversion. Could be due to mother's mental status thinking there's something wrong with her. How do you counsel a mom with inverted nipples? - Ask if and when nipple everts Look over shoulder after feeding to compare pre and post nipple look If nipple doesn't evert, intensive follow-up, consider milk expression, Assure adequate nutrition of infant.

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How can maternal obesity/overweight effect breastfeeding? - Could be a delay in lactogenesis II in first 7 days. Increases odds of early weaning, however if mother is seeking increased support, could increase BF duration and intensity Why is it important that mother's still breastfeed even after they have gestational diabetes? - Because it decreases their chance of getting DM later in life. W/ counseling support, can help increase intensity and duration of BF. What do some case studies suggest may help increase milk volume during lactation for woman who have PCOS? - Taking Metformin which may increase milk volume. Other studies however do not recommend this. How can pseudoephedrine effect milk production? What is it found in? - 60mg dose decreases milk production by 24% by decreasing prolactin levels. Is found in cold and flu prescriptions How can corticosteroids effect lactation? - Has caused temporary suppression of lactation (for 24-48 hours) in a breastfeeding woman. can possibly cause delay in lactogenesis II with preterm labor. If a woman was injected with this drug before labor and is having difficulty with production, it will eventually wear off.

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How does smoking effect milk and prolactin levels? Is this permanent? - It causes less milk production, they have lower prolactin levels. It is not permanent, after 12 hours of not smoking, milk production was similar to non-smoking mothers. How does smoking impact when weaning begins, and babies ability to nap? - Women who smoke more wean earlier (less likely to BF past 3 months) Babies who's mother's smoke sleep about 30 minutes less than non-smoking mother's w/ babies T/F: Quitting smoking decreases risk of premature birth. - True Which is more of a risk to passing on cotinine from cigarettes, breastmilk or second hand smoke? - second hand smoke Are nicotine patches safe for pregnant woman to use? - Women should only use these after approval from their HCP Which has more cadmium in it, breastmilk from mother's who smoke, or formula?

• Formula! Don't discourage mother's to not BF if they smoke, because formula has higher levels of Cd than their own milk

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mom if they use, how they feel about it, what they've heard from others, but still encourage breastfeeding! How does cannabis effect mother and baby? - Understudied, but there's not safe exposure threshold for anything that involves smoking. There has been a correlation between increased risk of preterm birth and low birth weight among pregnant cannibis users. Urge mom to be careful or quit using since there is a lack of data. Also Delta 9 was still measured in breastmilk up to 6 days after maternal use. How do you counsel someone who is tandem nursing? - May require specific teaching to help manage flow (australian posture is good for this) Less chance of engorgement Help parents respond to different needs of children. Nurse newborn first and more frequently Find ways to spend time with other child How do we counsel someone who has a baby using a pacifier? - Ask questions about why they are using a pacifier. Often this means they are compensating for another issue.

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What are potential health issues that could occur from using a pacifier? - More likely to not be breastfeeding at 18 months if used pacifier, pacifiers are dropped and contain a lot of germs, could increase risk of diarrhea or ear infections What is the connection between pacifiers and SIDS(3)? - Pacifier use is connected to a DECREASE risk of SIDS because babies sleep lighter and are more alert. BUT breastfeeding protects from SIDS more than pacifier. Also, if a baby gets used to sleeping with a pacifier and then you take it away, this increases SIDS What does the AAP say about pacifiers? - delay use until breastfeeding is firmly established Are pacifiers beneficial for premies? - Yes! They may have an earlier hospital discharge, tube fed babies gain weight faster with pacifiers because they help improve physiologic responses (like suckling) Do nipple shields help with breastfeeding? - No! They can a decrease in milk supply by almost 60% (they are covering the nerves so sensation isn't as strong). Increased risk of readmission due to weight loss and hypernatremic dehydration.

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What is a good scale to use to see if a mother might have postpartum depression?

• Edinburgh Postnatal DepressionScale (EPDS) How can we prevent postpartum depression? - Positive, supportive counseling visits, empower woman (they cannot think they know nothing and we know everything), Confidence is key! They must feel higher levels of BF self-efficacy. If they seem discourage, ask them "why they feel this way"", tell me more", etc. How do you counsel people who are worried about their milk supply? (6) - 1. About 40% of US BF mothers are worried about this, 2. Breastfeeding is a confidence game, the more confidence, will lead you to blast through these challenges,

3. DO NOT give innapropriate reassurance, gather facts first.
4. Undertake evaluation and feeding assessment to get all facts before concluding anything.
5. Provide support on what is "real" and "perceived" cases of low milk supply.
6. Refer to local BF places.

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T/F: How to tell how much women "know" things is related to age, IQ, social or ethnic group or race. - False. It is more related to life circumstances, how they view their place in this world and their relationship with others. How best can women move from one perspective to another? - Being in relationship (such as breastfeeding counseling) What are characteristics of a Women in Silence? - voiceless, powerless, afraid of words, see themselves as dependent on others for survival, do not trust their ability to understand or remember. How do you develop a relationship with Women in Silence? - Use few words, use familiar words they will understand, let silence be, do not just keep talking. don't give them things to remember, be their advocate. What are characteristics of a Receiver of Knowledge? - They believe all authorities tell the truth. Like to learn the right answer and repeat it to the teacher. Submits more to authority, not their inner voice. Sense of self is embedded in external definitions and roles around them (i.e. a good mom breastfeeds for a year, etc.)

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to understand other people's points of views, may constantly change HCPs or attend a variety of classes How to develop a relationship/counsel a Procedural Knower? - They may want very technical information on breastfeeding, Be prepared to back up statements with evidence. Be knowledgeable about multiple sources, limit personal stories, understand that options and change are normal for them. What are characteristics of Constructed Knowers? - Truth is constructed on own personal truth regardless of way they were raised, Have abandoned "either/or thinking", Avoids compartmentalizing "thought and feeling", "Home and work", Wants to embrace all pieces of self as one whole being, Wants to contribute to empowerment and improvement of quality of life for others, Have large "empathetic potential", but can still feel lonely What is the hierarchy of infant feeding choices for a term baby? - 1. Baby at Mother's breast

2. Mother's own expressed milk/Pumps
3. Milk from HMBANA (Human Milk Banking Association of North America) or State licensed milk bank
4. Cow Milk Formula

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5. Soy Formula What are concerns with using breast pumps? - Cleaning guidelines must be followed by CDC, Can influence babies gut microbiota since there's no breast contact, Can cause breast pain and injury, No one pump may be perfect for every situation, Decreased odds of BF at 10 weeks, If a flange on pump is too tight around nipple, milk will not come out b/c ducts are squished, this can lower milk supply if milk is not released. If a mother's milk supply is low, is increasing the amplitude and vacuum on a pump a good idea? - No! This can cause more pain, lengthen the nipple, and cause localized inflammatory changes as well as decrease milk collection. It is important to find the right amplitude and vacuum depending on the person. If a mother is using a pump early after delivery without an identified breastfeeding problem, what does this indicate? - Need for more lactation support to reduce concerns about insufficient milk supply. Is there one flange shape that is best for all women? - No! Nipple sizes change after delivery and during pregnancy, need to see entire pumping session before finding appropriate shape/tunnel size.

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What are the best ways to warm human milk? - Warm over a period of 20 min. in lukewarm water (no more than 40oC). Microwaving is not recommended b/c thawing doesn't happen evenly, How long is milk good for at room temperature (16-29oC or 60-85oF)? - 4 hours optimal 6-8 under very clean conditions. How long is milk good for in the refrigerator (~4oC or 39.2oF)? - 4 days optimal 5-8 days under very clean conditions. How long is milk good for in the freezer (<-4oC or 24.8oF) - 3 months is safest, and has highest amount of nutrients/fat content. 6 months optimal. 12 months acceptable. What are the benefits to donor milk? - Reduces long-term morbidity, reduce mortality among infants who are at risk of dying, Decreases NEC (infant intestinal disease), cost-effective, safe

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Is it safe/effective to add a little bit of moms milk to donor milk? - Yes, a study was done where a little bit of moms milk added began to change donor milk to look more like mom's milk. Why is informal milk sharing not okay, but donor milk is? - Because donor milk has been screened for history, serology, bacteriology on milk, and heat treatment/pasteurization to maintain optimal nutrients What are the negative components of buying milk over the internet that is not from a donor bank? - higher overall bacterial growth, contained caffeine and cotinine, many might contain cows milk or formula. What are common concerns with formula use? - It is frequently recalled, Formula can be contaminated during manufacturing process, Powdered formula is susceptible to contamination. What is the concern with powdered infant formula? - The growth of Chronobacter. Powdered formula is not a sterile product. Chronobacter can survive low water activity up to 2 years, and can produce a biofilm. Also results in 80% mortality rate if babies consume this.